I am staggered at the fuss over the announcement that failing hospitals may be handed over to private sector management teams or taken over by successful trusts.
Replacing chief executives and senior managers in one way or another has been the standard response to serious performance problems in the NHS for the last 20 years.
While it must be true that weak leadership is often a big factor in poor organisational performance (leaving aside the times when good people have been the victims of cowardly political responses to tabloid sensationalism), it is also true many good managers have fallen victim to circumstances that would challenge the strongest teams.
NHS chief executives are well paid and they must live up to high expectations and pay the price if they fail. Yet this announcement has a familiar ring, pretending as it does that the complex challenges facing organisations in trouble can be fixed with a change of management team. It might be more honest to say some hospitals simply are not viable on their own (as the Monitor approval process is revealing) and there will have to be more radical structural changes. The analogy that comes to mind is flogging the rider of the dead horse in the hope of getting the horse back on its feet.
There is also the issue of getting incentives right for hospital consultants who, above all, can make or break the management team's efforts to deliver against performance targets (especially on access, resource use and patient safety).
As with GPs, the new contract for consultants significantly (and justifiably) improved pay but failed to provide the performance levers intended. The proposed new failure regime would partly redress this if the same performance floor that triggers a change of management is also used as the threshold below which the consultants would not be eligible for excellence awards until a specified level of organisational performance had been achieved. This would be both equitable and potentially very effective. Admittedly this is a blunt instrument, but then so is sacking all the management team.
Frank Burns, healthcare consultant and retired NHS chief executive