Exclusive: Failing trusts will pay for new intervention regime

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Failing trusts will have to pay for their support
New regime focused on ‘conditions for success’ including leadership and staff engagement
Overhauled team ‘will use more management consultants’

NHS England’s new “provider improvement programme” is expected to cover about 15 trusts which will have to pay for NHSE’s interventions themselves, HSJ has learned.

NHSE is also beginning a restructure to cut and overhaul its RSP team into a new PIP team, despite concerns from staff, according to internal documents.

They say the new, renamed regime is generally expected to cover about 15 trusts at a time. They will normally enter when they have the lowest level of performance under NHSE’s new performance regime, and are judged to have a “low” capability to improve. Those which have “suffered a catastrophic failure of governance, either [of] quality or finance” will also be likely to enter the PIP, according to documents seen by HSJ.

According to a document seen by HSJ, as of a month ago, NHSE expected 10 trusts to enter the PIP, but a list is still being finalised based on the overhauled national performance and assessment framework.

Alongside the changes, NHSE has launched a consultation on restructuring its RSP team ahead of other parts of the planned merger of NHSE and the Department of Health and Social Care. The RSP team is expected to see a 27.8 per cent cut in whole-time equivalent posts, from 51 to 37.

HSJ understands members of the team have raised concerns that the speed of their changes will leave them disadvantaged in the reorganisation, or lead to further disruption.

One source said the changes would mean more cost from external temporary staff and consultancy. The PIP regime will use senior figures from outside NHSE, on a temporary basis, and management consultants, documents suggest.

One states: “A blended support model will be agreed, [with staff ] deployed from across: the NHSE team, including from the PIP team (depending on capacity and capability); from the wider NHS family, including temporary board appointments, buddying or other NHS organisations; and/or consultancy support under a national commissioned framework.”

New regime for failing trusts revealed

NHSE documents seen by HSJ say the existing recovery support programme, launched in 2021, has lost its “role and identity” and is inconsistent in its “model of intervention/support”, and criteria for entry and exit.

One document says the staff are not sufficiently senior and experienced, stating around “50 per cent do not have board level experience”.

RSP was applied to ICBs and providers, but the former will not be part of the new PIP, meaning: “An [separate] approach to the failure of strategic commissioning will be required.”

There will be fewer organisations in PIP, with it “limited to [about] 15 organisations with clear entry criteria”. That is down from 25 trusts and ICBs currently in the RSP.

Those entering will be “organisations in segment 4 of the [new] NHS Performance and Assessment Framework (NPAF)” due to poor performance and quality, “who also have a low provider capability rating”.

Trusts that “have suffered a catastrophic failure of governance, either quality or finance” will also be considered for inclusion “irrespective of their segmentation”.

The documents say that, instead of performance delivery itself, the new regime will focus on “the conditions for success”. These are: board and leadership effectiveness, “link with clinical body” and staff engagement, governance, “maturity of improvement approach”, and “structural barriers to improvement”.

PIP will begin with an external “diagnostic” on each organisation to establish where it falls short and to decide the form of intervention.

An internal document says: “It will no longer be within the scope of this team to provide support to improve the delivery of quality, finances or access; existing improvement teams will undertake this role and will be coordinated through regional input.”

It adds: “Most of the costs of the support model would be incurred locally by providers to ensure accountability… and to not incentivise entry into PIP.

“The programme would hold some non-pay resource to commission urgent interventional support by exception where necessary.”

Earlier this month Wes Streeting warned that trusts which fail to address longstanding financial problems could be “placed into administration” or taken over by another provider. He also indicated there would be tougher regional intervention to reconfigure services where necessary.

The PIP documents state: “Where diagnostic identifies clear structural barriers to improvement and there is no agreed plan to improve, or improvement remains slow, escalation to a joint taskforce of the national executive will occur and they will be responsible for ensuring the appropriate strategic solutions are in place.”

An NHSE spokesperson said: “The way we work with challenged providers needs to move away from just focussing on symptoms to one where we support the boards of organisations to achieve sustainable success, whatever that might take.

“We’re working closely with providers to shape a new approach to national support arrangements going forward.”