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NHS centralism is in the small print

Richard Vize

Richard Vize

Buried within the 59 pages of brittle-dry prose of an "impact assessment" on the failure regime for foundering trusts are extraordinary assumptions by the Department of Health about how many providers will go to the wall.

There is nothing alarming about a failure regime per se - it is a long overdue and necessary tool to ensure the effective running of services. What is worrying is the high and sustained failure rate contained in the paper, which has been signed off by health minister Ben Bradshaw.

"This betrays little faith in the performance architecture the government has put in place to keep trusts out of trouble"


Six deficit-ridden trusts appear slated for regime change. But instead of assuming that once the worst ones have been dispatched the overall performance of the NHS will improve, it maintains the assumption of a 2.1 per cent failure rate for the next 20 years. This amounts to 92 trusts.

The DH is now trying to backtrack, claiming the assumption is only for economic modelling purposes. But that does not square with the document itself, which describes the 2.1 per cent figure as conservative. This betrays little faith in the performance architecture the government has put in place to keep trusts out of trouble, notably foundation trust regulator Monitor.

Culling the herd

A failure regime has always been spoken of as something to be used only rarely, but this paper transforms it into a routine mechanism for killing trusts off - close to one every couple of months. This would gradually lead to a concentration of provider power, and a consequent atrophying of choice and competition.

Local accountability would also be undermined; with the failure regime dominated by the NHS chief executive and secretary of state, the consultations provided for are likely to be of little consequence.

The DH needs to spell out how it sees the failure regime operating and how it will address the fallout. Until it does so, managers could be forgiven for thinking it amounts to a mechanism for the widespread, centrally dictated reconfiguration of services.

Does the failure regime undermine local accountability? Email hsj.feedback@emap.com


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Reader Response

Added: Friday, 19 September 2008 15:45 BST
Mary Hawking, Dunstable, United Kingdom

I assume that bringing PFI commitments into the balance sheets - especially seeing PFI was invented to conceal public debt - will push a good many other Trusts with PFI commitments into the "unsustainable" category?
How does this impact on the rest of the local health economy?
Previously we were being told that if there were two secondary Trusts, one with PFI and one without, the one without was at risk - the Treasury had no intention of bailing out the PFI debt..
Does this regime (with only 30 days of public engagement, mind you) solve that problem - or will the secondary care Trust survive at the expense of the rest of the local health economy?


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