Editorial 6 June 2008: Franchising management (again) for failing trusts…

except it’s not franchising and we don’t know what they mean by ‘failing’. Unsuccessful 2001 policy re-announced in motivational boost for NHS managers.

by Andy Cowper, editor, Health Policy Insight

The Department of Health has launched a new outline document ‘Developing The NHS Performance Regime’, to address consistently poor-performing NHS trusts.

After a failing NHS trusts has failed a series of further tests, they will be declared ‘under directions’ of NHS chief executive David Nicholson. This seems at odds with the document’s statement (p.7, para. 7) that “this increasingly devolved and plural system cannot and should not be controlled from Whitehall”, and hardly looks like a triumph of decentralisation.  

The failing trust’s board will be removed or suspended and the chief executive will lose ‘accountable officer’ status to a replacement, possibly from the private sector.  

Foundation trusts will be encouraged to consider taking over failing organisations. This happened to Good Hope NHS Trust in Birmingham, which was privately managed by Tribal Consulting prior to being taken over by Heart of Birmingham NHS FT.

Health Minister Ben Bradshaw described Tribal’s achievement at Good Hope of a one-star Healthcare Commission rating (up from zero) and subsequent takeover as “a success”.  

Meanwhile, PCTs deemed to be failing might be taken over by other PCTs or have some or all functions outsourced. The potential implications of this for commissioning and indeed provision are huge, and the framework for procuring external support (FESC)-approved companies are likely to look at this with keen interest.

NHS Alliance chief executive Michael Sobanja said, “it’s right and proper to have a robust performance management regime to see that we spend public money wisely. There is an issue about failing organisations having alternative management arrangements if it obstructs public accountability. An outsourced, PCT board has to keep its public accountability sacrosanct. Replacing a failing board doesn’t mean outsourcing the PCT board – it’s vital to preserve the board’s accountability to local people and local clinicians for tax-raised funds”.

Waiting for metrics
However, the metrics and parameters to be used are “being developed”, according to DH director of finance David Flory, and will not be published until later this year.

In the intervening time, strategic health authorities will be left wondering what they exist to do. Their proclaimed responsibility is to