Zero options

Published: 21/02/2002, Volume II2, No. 5792 Page 13 14 15

NHS chief executive Nigel Crisp was, of course, absolutely right.You're turning the corner on performance and patient access, local people are on your side, and then - wham - It is raining the type of body blows you usually see at a Mike Tyson press conference.

The headlines are shouting that you are an abject failure, you have zero-stars and, as far as the public is concerned, you're bound to be killing patients. Before you can whisper 'devolution and earned autonomy', the media is yelling with glee that you are going to be privatised and your chief executive replaced with a dynamic private sector franchisee from Snappy Snaps or Wimpy. Or perhaps Enron? British Airways? But do not worry, Nigel saw it all coming.

'I realise this news may have shocked you and will cause uncertainty in your organisation, ' he wrote with uncanny prescience to the dumbfounded and angry staff at Ashford and St Peter's Hospital trust last week as the media mushroom cloud expanded.

Fresh from the trauma of achieving a zero-star rating last September, on Tuesday last week staff awoke to the news that the trust was one of four whose management will be franchised.

This didn't go down too well at Dartford and Gravesham trust, Portsmouth Hospitals trust, or Barnet and Chase Farm Hospitals trust either. These trusts have announced widespread improvements, and Barnet and Chase Farm's new interim chief executive, Paul O'Connor, the former director of operations at King's Healthcare trust, only started work on the same day the franchise announcement was made.

To make a delicate situation worse, all four trusts heard that they were up for franchise via their local media before they heard the official line from Richmond House.

'That didn't really help morale, ' said Dartford and Gravesham trust chief executive Sue Jennings.

'Especially as the media coverage was unfair. We are not a failing trust - we expect to get at least two stars now.'

Following the announcement Ms Jennings invited staff to a lunchtime meeting: 'The room was packed with people who wanted to know why we are being called a failure when we are not.

They also said they wanted a period of stability.'

Of course, the exact details of how to go about bidding for a franchise are lagging a little behind headline hyperbole. One thing made clear by Mr Crisp is that bids will be accepted from 'experienced NHS managers' only. But it will be almost a month before the Department of Health issues guidance on how to franchise. For that reason Ms Jennings, like Alan Bedford, her counterpart in Portsmouth, wants to keep her options open.

'I enjoy working here but it depends what the franchise details look like and whether I think It is possible, ' she says.

Dartford, Gravesham and Swanley primary care trust chief executive Stephanie Swanwick would support a franchise bid from Ms Jennings.

'There were a lot of confidence issues for local GPs, but in the short time she has been here she has established good relations with us and the trust has made significant progress against performance targets.

'The local health community was very disappointed in the way that the trust was described. Over the past months media coverage has told a success story so we must rally the flag again.'

Ashford and St Peter's Hospitals trust interim chief executive Andrew Morris says he will not be applying for the franchise and intends to go back to his old job running Frimley Park Hospitals trust: 'It is my job to prepare the right foundations for an incoming chief executive.

'I am confident that we are going to achieve most of the key targets.

The trust position is turning around. We even got a letter recognising this from Nigel Crisp.

The Commission for Health Improvement did its review of services last autumn and that was very positive about clinical services and we are seeing a turnaround on key access targets as well.'

Others are not certain that the franchise trail will be so popular.

Portsmouth City primary care trust chair Zenna Atkins says her local health community is 'keen to see a new chief executive as soon as possible.

'But I do not think there are a surplus of three-star chief execs around who are going to want to try to turn around the biggest non-teaching hospital in the country. It is a very deprived area and there is a real challenge recruiting doctors and nurses. A new chief executive would have to come in mid-way through a big private finance initiative project as well.'

Ms Atkins says that she wants to see the franchise process handled through the regional office in conjunction with the trust chair.

'In that way the plan to turn the trust around would develop after the new chief executive came in. I do not want to see someone appointed from a central list.

'If franchising does what it says on the label and brings in the best of the NHS to help us then of course we would be delighted. But it might prove to be great in theory and not deliver in practice.'

Paul O'Connor, who has spent the past six months working on secondment to the London regional office as director of the winter planning team, is confident that he is the right man for the job.

'I am not here to give short-term sticking-plaster solutions. I intend to do everything possible to ensure stability and the further development of Barnet and Chase Farm Hospitals by winning the franchise and by being appointed its chief executive on a long-term substantive basis.'

Barnet PCT chief executive Averil Dongworth supports the idea of bringing in strong leadership via franchising. 'But I am not sure how possible it will be to get someone who is doing well at a three-star [trust] to manage a nostar as well.'

And she points out: 'The reason that these people are managing three-star trusts is that it is all about strong personal leadership - if you are working in two places It is more difficult to keep your eye on the ball.'

Jonathan Baume, general secretary of the First Division Association, which represents NHS chief executives, says the FDA is 'not convinced that the secretary of state would be justified in bringing in new management teams other than in exceptional circumstances.

'The NHS reforms will only succeed if the existing managers are given the support and resources necessary to manage to succeed in the complex jobs they have undertaken.'And he is certain that franchising will not appeal to managers outside NHS.

'The FDA is sceptical that the private sector can help, as it has no experience of managing large trusts. The secretary of state has recognised this by transferring in managers from other trusts.'

Somewhat surprisingly, in the face of staff disquiet at what they see as a process which undermines local efforts, Unison supports franchising to other NHS managers.

General secretary Dave Prentis says: 'Unison welcomes the government's decision to bring in real experts to turn around failing hospitals.

'These experts are currently working in the NHS providing beacons of good practice. They know the problems, they've experienced the waiting lists and they have introduced innovative and imaginative solutions to overcome them.

'There is no doubt that sharing these managers will give a real boost to hospitals and staff they are set to manage.' l