Hospital trusts are increasingly run like football clubs, if you’re in the relegation zone at Christmas then sack the manager and bring in a new one with their own staff. It rarely stops the slide because there are no quick fixes. The process of rebuilding is slow and often involves living within reduced means and always involves repairing a damaged reputation among local people.

‘One trust can continue to be in special measures while underperforming trusts are not in special measures’

There have already been 49 leadership changes at the 14 hospital trusts placed in “special measures” last year. This smacks of desperation and a misguided view that the appointment of a “special one” will see a quick and dramatic change in fortunes.

The experience of getting out of special measures in other parts of the public sector is that it will take years rather than months, that despite improved performance the damage to the hospital trust’s reputation will take much longer to repair and that the goal posts are continually moving.

Even though you have successfully addressed all the issues that got you into special measures, the resulting closer scrutiny means new issues are being identified for you to resolve before you can be removed from the list of shame.

Kafka-esque scenario

This can result in the contradiction of the trust continuing to be in special measures while underperforming trusts are not in special measures. The board which finds itself in this position often compares it to a Kafka-esque situation because no one seems clear about what you have to do to get out of special measures and who really makes the key decisions.

My answer to any board that finds itself in this position is that from my experience you have to serve your time, which is as much about sending a message to others as it is about demonstrating improvement and the potential for improvement.

And what should we gather from the Mid Staffordshire decision? In some people’s view the trust has turned round, yet it is now declared economically unviable. Indeed, it was the desire to avoid this in the first place that led to the disastrous overemphasis on budgets at the expense of care. A no-win situation or another example of the Kafka-esque situation that exists for many NHS hospital trusts?

Topics