Wes Streeting has warned NHS bosses that they will be sacked and blocked from taking a job in the sector again if their hospitals fail.
The health secretary made it clear that he intends to end the culture of NHS executives being fired from one job for failure, only to be given another job at a different trust.
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 payoff in one trust and then reincarnate in another NHS trust.
“Those might be the rotten apples, and I want to recognise that there are some outstanding leaders right across the NHS, but those rotten apples are unacceptable and give the rest of the profession a bad name.”
The drive for efficiency saw a surprised Mr Streeting compared to X boss Elon Musk who has just been handed a role advising Donald Trump’s proposed Department of Government Efficiency (DOGE).
But his plans to impose league tables, which his adviser Alan Milburn, tried to introduce 23 years ago when he was health secretary, left another former Tony Blair adviser Matthew Taylor, now chief executive of the NHS Confederation, angry.
He said that “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 health and staff shortages, need to be identified and supported in order to recover.”
The row came as Mr Streeting gave a major speech in Liverpool warning that the NHS is living on “borrowed time” and will not survive if Labour cannot improve it.
He told leaders at the NHS Providers conference there was a need to “recover and renew” the health service.
Mr Streeting said: “The prime minister pledged the biggest reimagining of the NHS and it falls upon all our shoulders to deliver this – the jewel in the crown of this government’s decade of national renewal.”
Mr Streeting told NHS leaders “we are in this together”, adding: “The NHS is already living on borrowed time and if a Labour government can’t improve the NHS, then it simply won’t survive.”
It comes after the health secretary said 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.
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”.
Under 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.
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 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 underinvestment 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.”
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.”
