With just five weeks to go before non-foundation trusts have to outline their plans for joining the elite, there are severe doubts about the government’s aspiration for foundation trusts to rescue weaker hospitals.
The warnings come after Mark Goldman announced he is quitting as Heart of England Foundation Trust chief executive, three years after leading the only acquisition of a hospital by a foundation.
While one trust’s struggle to make a takeover work does not prove they are a bad idea, Heart of England’s decline since it took on the ailing Good Hope Trust should act as a warning
His hospital has a good reputation, but in the years since the takeover its annual health check quality score has dropped from excellent to good to fair; now Monitor has raised concerns and there is vocal opposition to plans for service changes.
While one trust’s struggle to make a takeover work does not prove they are a bad idea, Heart of England’s decline since it took on the ailing Good Hope Trust should act as a warning to avaricious boards.
It was one of the more naive aspects of New Labour’s public sector reform drive to believe that if, for example, you put a bad school and a good school together, you ended up with two good schools. The Good Hope story shows this is by no means certain. Expectations of rapid improvement were not met.
Judging by the string of plaudits left for Dr Goldman on hsj.co.uk - paying tribute to a surgeon who successfully made the transition to chief executive - the problem is not weak leadership or lack of clinical engagement. One contributor praised the way he had handled one of the toughest jobs in the NHS.
The root of the difficulties may be that the acquisition was predicated on financial necessity - Good Hope simply wasn’t sustainable. Now, Dr Goldman - who writes this week’s opinion column - believes any mergers must be built on quality, safety and performance needs.
Then the wider system - regulators, the Department of Health, politicians and the public - need to have more realistic expectations about how much can be achieved, and how quickly. Success will take years, if it ever comes.