Failing managers to be axed under new NHS regime

David Nicholson

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Managers at failing trusts will be replaced with teams from the private sector or other NHS organisations under a tough new performance regime.

The Department of Health will also name and shame hospitals and primary care trusts with poor safety and clinical records.

The measures are set out in a document called Developing the NHS Performance Regime.

Managers in Partnership chief executive Jon Restell said he feared the changes would result in a "bully's charter". "We are not convinced that the accountability framework is yet strong enough to handle this regime," he said.

New minimum standards of quality, safety and financial management will be established and trusts failing to meet these criteria will be identified as "challenged".

NHS chief executive David Nicholson will be responsible for ensuring all challenged trusts have agreed performance improvement plans with strategic health authorities. These will have defined time periods and milestones against which improvement will be assessed.

Trusts unable to turn around their performance in the expected time will be deemed to have failed.

The NHS chief executive will also have responsibility for establishing a turnaround plan and replacing managers with a team from other parts of the NHS, foundation trusts or the private sector. This would happen through merger with an FT, or a private sector management contract. No NHS assets or staff would shift to the private sector, the DH has stressed.

NHS Confederation policy director Nigel Edwards said he was "disappointed" with the "anti-management rhetoric" in the document. "It seems they have put this in extremely quickly and with very little consultation," he said.

It was unfair to "ruin careers" when there were many reasons for failure other than bad management, he said. Managers would be "mad" to take over a "basket case trust".

The DH has also set out insolvency principles to ensure borrowing does not put NHS assets or the continuity of services at risk.

The quality, safety and financial criteria on which failure will be judged will be published in October, when the DH also plans to announce the number of trusts deemed to be underperforming.

Successful trusts will be given increased freedoms through achieving foundation trust or world class commissioning status.

A DH spokeswoman said: "In addition to enabling success, the NHS must prevent poor performance and, when it does happen, to intervene and take action to turn organisations around in the interest of patients."

Health minister Ben Bradshaw told HSJ managers would be consulted over the coming months. 

He said: "We're not making the assumption that poor hospitals are down to poor managers. The early stages of this process give us enough options to keep management as it is if there are other solutions.

"But normally there's a strong correlation between poor standards and poor management."

For more on the failure regime, visit the news section and see next week's news analysis.

Watch an interview with health minister Ben Bradshaw on the measures.