24th October 2019

Dr Andy Spencer, Clinical Director of Child Health at the North Staffs Hospitals sent out an invitation to to discuss “opportunities for developing greater collaborative links” between provider of paediatrics in the area.

A full copy of the letter can be accessed here.

Behind the letter was some history. By the late 90s, the internal market which had been introduced in 1980 by Margaret Thatcher’s Conservative government had taken a firm hold in some areas of service, but the market had been of little relevance to paediatric care. The separation between purchaser (later ‘commissioner’) and provider had left District Health Authorities and the providers – quickly moving to independent NHS Trust status – with both technical and cultural-political changes to the organisation and management of health care.

The involvement of clinicians in the management of services, that Sir Roy Griffiths, MD of Sainsburys had recommended, had been focused largely on the internal organisation of hospitals and community services. When they did look outside, the focus, with their business managers, was on securing and managing ‘contracts’ with the purchasers. In general paediatrics, block contracts remained the dominant currency-in-use, and providers were left simply to manage demand within the budget they could claim.

But pressures and anomalies were building up. District Health Authorities, by and large, were unaware or uninterested in changes in paediatrics: this was certainly the case in North Staffordshire, where the pressures of extending provision into the sub-speciality services that were starting to spread beyond the Children’s Hospitals were being felt ‘acutely’ (apologies for the pun).

Though there were regional groups focused on clinical matters, there was no forum for clinicians to look at the pattern of services, and of investments in services that were needed across the wider piste. With no place to take these issues of resourcing, organisation of services and quality of service, an invitation to other children’s service providers in the area to explore the state of play and possibilities for collaboration made good sense.