Failing hospitals will be named and shamed in league tables and NHS managers sacked if they cannot improve patient care and take control of finances, under Government plans.
Health Secretary Wes Streeting is telling leaders at the NHS Providers conference in Liverpool there “will be no more rewards for failure” as he sets out a package of measures aimed at tackling poor performance.
NHS England will carry out a “no holds barred” review of NHS performance across England with the results made public in league tables which are regularly updated.
NHS trusts can expect to be ranked on a range of indicators such as finances, delivery of services, patient access to care and the competency of leadership.
Health leaders hit back at the move, saying it could demoralise staff, and accused ministers of “falling for the appealing notion of a magic productivity tree which will make the NHS more efficient just by shaking the magic tree harder”.
Speaking on Wednesday, Mr Streeting told BBC Radio 4’s Today programme that “where we have poorly performing senior managers, I’ll make no apology for managing those people out, because people know – and this is the guilty secret of the NHS – there are very senior managers who are paid on average let’s not forget £145,000 a year, who are managed out, given a pay-off in one trust and then reincarnate in another NHS trust”.
Under the Government plans, persistently failing managers will be replaced and turnaround teams sent into trusts that are running big financial deficits or offering patients a poor service.
There’ll be no more turning a blind eye to failure. We will drive the health service to improve, so patients get more out of it for what taxpayers put in
Meanwhile, the best NHS performers will be given greater spending control to help modernise their buildings, equipment and technology.
The Department of Health said there is currently little incentive for trusts to run budget surpluses as NHS trusts are unable to benefit from them, but that will now change, with top-performing trusts given more of this cash.
Mr Streeting said: “The Budget showed this Government prioritises the NHS, providing the investment needed to rebuild the health service.
“Today we are announcing the reforms to make sure every penny of extra investment is well spent and cuts waiting times for patients.
“There’ll be no more turning a blind eye to failure. We will drive the health service to improve, so patients get more out of it for what taxpayers put in.
“Our health service must attract top talent, be far more transparent to the public who pay for it, and run as efficiently as global businesses.
“With the combination of investment and reform, we will turn the NHS around and cut waiting times from 18 months to 18 weeks.”
These reforms signal an important drive for positive change in our health system
NHS chief executive Amanda Pritchard said: “While NHS leaders welcome accountability, it is critical that responsibility comes with the necessary support and development.
“The extensive package of reforms, developed together with government, will empower all leaders working in the NHS and it will give them the tools they need to provide the best possible services for our patients.”
Mr Streeting has already announced that failing NHS managers will be denied pay rises if they do not improve patient care or get their finances in order.
A new pay framework for very senior managers will be published before April next year, with those who do well given financial rewards.
The deputy chief executive of NHS Providers, Saffron Cordery, said the scale of the challenge facing NHS leaders was “huge” and they were “pulling out all the stops to boost productivity while delivering tough efficiency measures”.
She added: “It’s vital we take decisive action to tackle the deep-rooted causes of pressures on the health services including the lack of resources for public health, prevention and social care, chronic workforce shortages, financial shortfalls and historic under-investment in the bricks and mortar of the NHS which underpin so many of the challenges we face today.
“Taking steps to resolve these root causes is critical before any plans to introduce league tables and threats to ‘sack failing managers’ are even put on the table.
“Trust leaders are highly accountable, subject to rigorous standards and stand ready to tackle the challenges ahead, as they have always been. League tables bring with them significant risk of unintended consequences.”
League tables in themselves do not lead to improvement
Matthew Taylor, chief executive of the NHS Confederation, said “the prospect of more ‘league tables’ will concern health leaders, as these can strip out important underlying information.
“NHS staff are doing their very best for patients under very challenging circumstances and we do not want them feeling like they are being named and shamed.
“League tables in themselves do not lead to improvement. Trusts struggling with consistent performance issues, some of which reflect contextual issues such as underlying population heath and staff shortages, need to be identified and supported in order to recover.”
Many of the drivers of poor productivity are systemic, from the dire state of social care stranding people in hospital, to crumbling roofs and worsening population health
Nuffield Trust chief executive, Thea Stein, said: “We know from the special measures for quality regime that naming and shaming NHS trusts can make it harder to recruit staff, which doesn’t help patient care at all.
“It’s unclear what new league tables will measure – a table based on general waiting times doesn’t add much if you need to know how good heart surgery is…
“Ministers have long warned the NHS against the naive belief in the magic money tree.
“But they themselves are at risk of falling for the appealing notion of a magic productivity tree which will make the NHS more efficient just by shaking the magic tree harder, rather than by changing the drivers of efficiency.
“That can only lead to the NHS being forced back into asking for ‘more, more, more’, with patients ultimately paying the price.”
Mr Streeting will also tell Wednesday’s conference how NHS trusts could be banned from using agencies to cover staffing gaps such as healthcare assistants and cleaners, in a bid to cut the £3 billion a year spent on agency workers.
Those NHS staff who leave permanent jobs could also be stopped from coming back into the health service through expensive agencies.
Rachel Power, chief executive of the Patients’ Association, said: “The focus on tackling poor performance and rewarding excellence sends a clear message about raising standards across the NHS.”
