Trusts deemed by the Department of Health to be “failing” could see their management removed and a new management team brought in from other parts of the NHS, NHS Foundation Trusts or the private sector under plans announced by Health Minister Ben Bradshaw to “drive up standards of care and tackle underperformance in our hospitals and primary care Trusts”.
The proposal is among a number set out in the recently published “vision document”, “Developing the NHS Performance Regime”, which lays out plans for the establishment of new minimum standards of quality, safety and financial management for Trusts. Those deemed to be failing to meet the various criteria are set to be identified as “challenged”, with the NHS CEO to be responsible for ensuring that all such Trusts have agreed performance improvement plans with Strategic Health Authorities. These will have defined time periods and milestones against which improvement will be assessed.
The Department of Health also simultaneously set out insolvency principles for Foundation hospitals and non-Foundation Trusts designed to ensure borrowing does not put NHS assets or the continuity of services at risk.
Ben Bradshaw said: "The NHS has come a long way in the last ten years, with record investment, more clinical staff, shorter waiting times, and better cancer and heart disease survival rates. However there are still unacceptable variations in performance, and a small number of NHS organisations where performance is not meeting the standards which the public and patients expect."
"As the Prime Minister made clear in his speech in January, we will not tolerate underperformance in the NHS and, for the first time, will publicly identify those Trusts with poor safety and clinical records. This new guidance sets out how we will tackle poor performance and the turnaround regime we are establishing for those hospitals and Primary Care Trusts identified as falling below minimum standards."
David Nicholson, NHS CEO, said: "There are already a number of good examples of how weaker performing Trusts around the country have turned around their performance, but we want to ensure consistency and introduce a clearer, more transparent system. Our new vision sets out what constitutes underperformance and failure and will be a valuable tool to support NHS managers, Trusts and Health Authorities. It will also establish public accountability by helping patients and the public understand how well their local NHS is performing."
The Department of Health explained that the “three main options” open to the NHS where Trusts are deemed to be “failing” are:
• New NHS management, drawn from “the top management pool”.
• NHS Foundation Trust management, deployed to Trusts through a merger of hospitals where an appropriate Foundation Trust is willing to take on this role.
• Private Sector management, provided on the basis of a management contract. While this will entail new management for the Trust, there would be no shift of NHS assets or staff to the private sector.
Later this year the Department says it will publish the quality, safety and financial criteria on which underperformance and failure will be determined and reveal how many Trusts are not meeting them. Primary Care Trusts and hospitals will be judged against “different but similarly challenging criteria”.
