Failing trusts face ‘administration’ regime, says Streeting

The health secretary set out the performance regime that will be outlined in the upcoming 10-Year Health Plan, which he said will be launched within “weeks”.

Elsewhere in his speech at the NHS Confed Expo conference today, he promised a “decade-long project of improvement,” starting in “working class, rural and coastal communities”.

NHS regions will be required this year to draw up plans for failing providers “and begin the process of turnaround”. DHSC will “step in” to support “underperforming providers”, the MP told the conference in Manchester.

Mr Streeting added: “Where there are failures in leadership and culture, the leadership will be replaced, with bonuses to attract our best leaders into our most challenged trusts.

“Where there are repeated financial problems, the failing provider may be placed into administration and taken over by another provider”.

A quasi-commercial administration regimes for failing trusts was created in law in 2009, extended to cover FTs in 2012, and remains in statute. It involves the trust being dissolved and its services closed or passed to other providers.

It was only used twice, about 10 years ago. In south London it resulted in a lengthy political and legal dispute over service reconfiguration, while the administration of Mid Staffs FT was also protracted and expensive.

A proposed new performance regime published by NHS England last month says for failing trusts, it will “consider whether long-term solutions are needed to address any structural issues”, but does not refer to administration or takeover.

‘Reinvention of foundation trust model’

Mr Streeting also promised a “reinvention of foundation trusts for the modern age” – with the 10-Year Plan introducing incentives and “freedom from central control” as rewards.

The health secretary said the philosophy of “earned autonomy” in the foundation trust model “has been lost over the last decade, as the bureaucratic culture of excessive micromanagement took over”.

There will still be seven NHS “regions”, he revealed, to manage provider performance, despite the consolidation of integrated care boards.

Integration

But Mr Streeting said the “reinvented” FT regime would mean they “can only succeed if they collaborate with community and mental health providers and GPs”.

They would need to “focus on outcomes, not activity, drive the left shift, and help to improve population health”, he said.

Mr Streeting also said he was “open to our strongest acute trusts providing not just community services, as many already do, but also primary care”.

“Indeed, I would hope that those old-fashioned labels – acute, community – become increasingly meaningless,” he said.

“Likewise, there is no reason why successful GPs should not be able to run local hospitals, or why nurses should not be leading neighbourhood health services”.

In a comment about the proposals for reinventing FTs, NHS Providers CEO Daniel Elkeles said it “could herald increased autonomy with freedom to innovate and build on success, alongside greater transparency and public accountability for performance”, which was “a winning formula”.

“It will be important that incentives and penalties are designed to keep patients safe, reward improvement and encourage great leaders to join and stay in the NHS,” he said.

‘Caution’ over PFI model

Yesterday, NHSE boss Sir Jim Mackey announced plans to allow private finance investment into health service infrastructure.

Mr Streeting said the NHS was still “haunted by the spectre of PFI”, pointing out that “trusts are still saddled with costs”.

But he said there were “some good models available” for private investment, including the “mutual investment model” being used in the NHS in Wales.

He said: “I just want to reassure people that I am treading cautiously in this area, because I always want to learn from what we got right when we were last in government, but also with the humility of the things that we got wrong”.