The NHS reform process has seen two chief executives quit in London and a chair and non-executive team depart in Bedfordshire. News reports in the Health Service Journal cover the resignations of Tara Donnelly, chief executive of West Middlesex University Hospitals NHS Trust and Julian Nettel, CE of Barts and the London NHS Trust.

Both trusts have failed to meet national targets on finance and patient access. Neither of them has achieved the semi-independent foundation trust (FT) status granted to financially secure and high-achieving trusts, which also removes FTs from direct control from the Health Secretary.

HSJ’s report also suggests that the strategic health authority (NHS London) is in turmoil and under pressure over the general performance of NHS trusts in the capital from the Department of Health.

Shaky foundations?
A spokesman for West Middlesex trust told HSJthat Ms Donnelly resigned after eight patients had needed to wait more than 12 hours to be admitted to the hospital through accident and emergency. Although no patients were harmed by the delays, the trust’s failure to inform the strategic health authority was clearly seen by NHS London as a capital offence.

West Middlesex Hospital was categorised as "financially challenged " in 2007, but improved in 2008.

DH policy is for all provider trusts to be given a provisional date by their SHA to reach foundation trust status before December 2010. Neither West Middlesex nor Barts and the London have yet been given a date.
In West Middlesex’s case, it is thought that the NHS trusts in that area of London may merge and reconfigure.

Barts and the London is the subject of serious concerns over the affordability of its new hospital: a private finance initiative (PFI) contract costing £1 billion. HSJstates that “from 2013 PFI repayments will eat up some 16 per cent of its turnover in facilities costs alone, just as NHS resources are expected to get much tighter. The hospital tariff assumes that facilities costs are equal to around 6 per cent of a hospital's turnover”.

The resignations of the chair and non-executive directors of Bedfordshire and Luton NHS Mental Health Trust are associated with issues around that trust’s potential financial viability. With annual revenues of £70 million, the trust is understood to have decided that its future lies in being taken over by a bigger foundation trust with the economic muscle to help its services survive in the new NHS world of patient choice and contestability from the private and third sectors.