commentRisks and price of failure for the first franchise remain worryingly high

This week the health service gets a step nearer to franchising. With Sue Jennings, chief executive of three-star Basildon and Thurrock, taking on the job of running no-star Dartford and Gravesham, the soundbite has become a reality. Not that there seems to have been a great deal of progress in fleshing out the detail of what franchising is actually all about.

As yet the franchise process has not been formally enshrined. But Ms Jennings and her team have, apparently at a moment's notice, agreed to attempt to turn around a failing trust while simultaneously trying to retain their own top-performance rating in the aftermath of a not altogether favourable Commission for Health Improvement report on Basildon and Thurrock.

Only a courageous individual would be willing to tackle two jobs at once - particularly when the personal and professional rewards on offer have not even been spelt out. Indeed, taking on the running of two major acute trusts - each with a history of problems with trolley waits - as winter starts to bite would be the stuff of nightmares for many managers.

Sue Jennings has gained a reputation for being a dynamic moderniser while retaining that supportive and enabling touch with which she has achieved successes in trusts other than her own through her leadership of the National Patient Access Team.

But she and her board at Basildon and Thurrock have their work cut out at home.

They have a 17-page action plan that they have only just begun to implement since that CHI report was published in September - a major challenge in itself. In addition, they must resolve the complex problems which face Dartford and Gravesham as the first trust to engage in a private finance initiative rebuild.

While the Department of Health knows it has to be seen to be doing something about failing trusts, at this point it seems that the policy-makers may still be guilty of developing the franchising concept on the hoof. It is not clear what benefits having one hard-pressed, high-profile chief executive run two organisations at once will bring. Yet there will inevitably be other franchises to follow. And already there is talk of extending similar arrangements to personal medical services pilots.

The sceptics who sounded warnings about the dangers of spreading the expertise of senior managers too thinly will be waiting to say 'I told you so', while the staff and patients of Dartford and Gravesham - and Basildon and Thurrock - will be hoping for success. But the price of failure is high - not one but two failing trusts.