And the door remains open for experienced NHS managers

Published: 22/08/2002, Volume II2, No. 5819 Page 17

There is a strong vein of pragmatism running through the Department of Health's plans to franchise the management of failing trusts to managers from outside the organisations. For a start, it speaks of building a 'register of expertise', consisting of those 'with the skills to offer coaching, mentoring, development, management consultancy, interim management and other specialised areas of support'.

Wisely, it also leaves the door open to 'include experienced NHS managers with good track records'. The management of three-star trusts, who have little incentive to get involved, are automatically being added to the register.

There is little indication of 'hit squads' blitzing failing organisations and none of the rhetoric that accompanied similar plans within local government, prisons and education. Given the acute political sensitivities of the NHS, this is just as well.

Though it is unclear where the '300-400' applications to be included on the franchise register will come from, one can guess that the majority will be from individuals or organisations already providing services to the NHS. Typically, many will be former NHS managers working in a consultancy role in a locality or speciality they know well.

In effect, what the DoH is doing is putting these organisations through a prequalification process. Given that the NHS, as it battles with the myriad demands of service improvement, will need this expertise in any case, it makes sense. It should, if done properly, add transparency to arrangements which - at present - can be a little murky. In stressing that NHS managers will be involved in this expertise network, the DoH is also showing that this is no private sector takeover. The approach suggests most interventions will be targeted at specific needs.

Some argue that the NHS should have all the necessary expertise in-house. This is impractical for good and bad reasons. Some very good managers will always prefer to be guns for hire, while others will have found themselves out in the cold simply because being an NHS manager can be a high-risk, high-stress business.

The DoH's register of expertise should become a useful tool for identifying those inside and outside the NHS who are best equipped to help failing parts of the service.

If it does not, the DoH will have not taken regard of the NHS's sensitivities over those with inappropriate motives or experience becoming involved in healthcare.

If that happens, franchising will fail both as a concept and as one of the potential cures for the NHS's ills.