Trust leaders prepare to bear the Francis burden

This month’s Barometer survey was the first opportunity to gauge trust chief executives’ reactions to the Francis report, and the results were something of a mixed bag. There was a wide range of views, but overall the report is expected to have a significant impact on providers.

There was general support for the principles underpinning the duty of candour, although chief executives were divided over the proposals for implementing the duty. Seventy-three per cent thought that the new chief inspector of hospitals would not be effective. The NHS has past experience of overall ratings of provider organisations during the Commission for Health Improvement era, and perhaps the lack of confidence in the new proposals reflects that experience. Not surprisingly, most leaders are expecting to face a heavier regulatory burden from Monitor and the NHS Trust Development Authority as a result of the Francis report.

Other questions focused on the position of provider organisations as we headed to financial year-end, and also the handover of commissioning responsibilities from primary care trusts and strategic health authorities to clinical commissioning groups and NHS England.

‘Chief executives delivered their final verdict on the effectiveness of PCTs and SHAs’

Given that we were approaching year-end, there was a high degree of confidence that providers would achieve their annual cost improvement programme targets. However, nearly 20 per cent of chief executives were sufficiently pessimistic as to suggest that their organisations would struggle to achieve their targets.

They also delivered their final verdict on the effectiveness of PCTs and SHAs, and overall this indicated a middling performance. However, there was a serious lack of confidence in the expertise, resources and support available to the new commissioners to carry out the commissioning role in future.

Finally, chief executives were given an opportunity to reflect on the issues that take up most of their time. Many referred to service reconfiguration, suggesting that further major changes may be needed in order to make provider services safe and sustainable.

There is also major concern about how providers will balance the books in future, especially in view of the funding arrangements, 30 per cent tariff and increasing activity in emergency care.

Peter Edwards is a senior partner at Capsticks