Published: 15/01/2004, Volume II4, No. 5888 Page 3 4

None of the senior management teams at the zero-rated acute trusts will be franchised this year, signalling that the controversial policy has been put on the back-burner.

This follows a decision not to franchise zero-starred primary care trusts this year.

Eleven trusts were given a nostar rating for the first time last July. Each has been subject to assessment by their respective strategic health authorities and HSJ has been told franchising was not being considered at any of them (see box overleaf ).

The no-star trusts had been told in the summer they faced the possibility of franchising if action plans for improvement were unacceptable, although this has not been put into practice.

This compares with when the policy was first unveiled by then health secretary Alan Milburn: six of the 12 acute trusts zero-rated in the 2000-01 round of star-ratings saw their management replaced.

The news is a blow to the eight private firms on the 'franchising and register of expertise', published over 12 months ago.

Even though all three-star acute trusts are automatically included on the register, only management consultants Secta have ever been offered work through the scheme.

It signed a three-year contract to turn around the performance of Good Hope Hospital trust in Birmingham.

A spokeswoman for Bupa, another firm on the register, told HSJ: 'We are on the franchise register but we haven't had the opportunity to bid for anything as yet.'

She said the Good Hope franchise had been the only opportunity to bid, but that was not the company's 'area of expertise'.

She added: 'It is not true to say we are sceptical [about the franchise register].We are very happy to help the NHS where we can. But the skill base we offer is not necessarily through the franchise process. I think in many ways [the franchise policy] has been symbolic.When it was announced, there was still a debate about the role of the private sector and to an extent that debate has now receded.'

The decision not to franchise any zero-star trusts occurs less than 12 months after the collapse of the franchise process for United Bristol Healthcare trust and Royal United Hospital Bath trust.

The Department of Health had announced in December 2002 its intention to replace UBH and RUH Bath's management - along with that of Good Hope Hospital trust - following zero stars in the 2002 ratings.

But after assessment by Avon, Gloucestershire and Wiltshire SHA the process was abandoned at Bath and Bristol, with the problems seen as too complex for a solution through individual franchises.

In a statement, the DoH said: 'In line with developing the policy to include a wider range of support options which SHAs can draw on, as well as franchising, the department will look to further develop co-operation with a wider range of private and voluntary sector organisations.'

What happened where?

Fourteen trusts were zero-rated in the July 2003 star-ratings.Three - United Bristol Healthcare, Royal United Hospital Bath and Good Hope Hospital -began the franchising process in December 2002.The situation with the others is:

North Bristol: strategic health authority says it is not franchised because the problems were across the local health community.

Maidstone and Tunbridge Wells: new chief executive in place in November 2003.

Royal Surrey County Hospital: SHA says there has been no discussion on franchising.

South Manchester University Hospitals: a new management team in place; franchising never discussed as an option.

North Cumbria Acute Hospitals: says new management is in place to 'take the organisation forward'.

University Hospitals of Leicester: SHA has 'confidence' in management team.

Stoke Mandeville Hospital trust and South Buckinghamshire (now merged), and Milton Keynes General: SHA covering the trusts says there are 'more ways of improving management at a challenged trust than simply franchising the whole management'.

Royal Shrewsbury Hospitals (merged in October 2003 with Princess Royal trust): SHA says there has been no franchise decision because of merger.

Isle of Wight Healthcare: says it is a 'special case'because it provides mental health, ambulance and community services, as well as the acute services for which it was zerorated.