Wes Streeting has defended a new NHS reform plan to sack failing bosses and “name and shame” struggling hospitals.
The Health Secretary unveiled his plan to “manage out” struggling managers from the NHS if they cannot improve patient care in a speech in front of trust leaders in Liverpool. He said it was the “guilty secret” of the NHS that failing chief executives are “managed out” of a role leading one trust - and given a huge payoff - only to reappear in a similar role at another trust. It follows a host of scandals at NHS trusts in recent years which have caused hundreds of unnecessary deaths.
Speaking at NHS Providers’ annual conference, Mr Streeting said: “I just think this is the NHS’s guilty secret. I’ve not had anyone tell me I’m wrong about this because everyone knows that it’s true. You have people that are known to be poor performers, who are often quietly managed out of trusts and often given a golden goodbye in the process, and then they are reincarnated somewhere else. And I just don’t think that’s acceptable.”
In a keynote speech to NHS leaders, he said: “The work you do couldn’t be more serious. When you get it right, lives are saved. When you don’t, the consequences can be tragic. For those judged to be persistently failing, we will act. We will go from zero consequences for failure, to zero tolerance.”
He said if NHS boards were concerned about their trust’s leadership “they should not be waiting to act”, adding: “I will be disappointed if as Secretary of State I’m regularly having to step in to point out poor performance to governing bodies and boards that really should be holding senior managers to account.”
Experts have warned of the “unintended consequences” of the new performance table which will cover all 215 NHS trusts in England. They will be ranked on a range of indicators such as finances, delivery of services, patient access to care and the competency of leadership. 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."
Saffron Cordery, deputy chief executive of NHS Providers, which represents hospital bosses in England, urged Streeting to focus instead on the "deep-rooted causes of pressures on the health service" such as lack of NHS funds and the social care crisis. She said: "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."
Crumbling hospitals following a decade-long squeeze on NHS capital funding has been blamed for poor productivity in the health service. The recent Darzi report identified this as the main reason a 20% increase in NHS funding in the last five years only increased the number of patients treated by 3%.
Thea Stein, chief executive of the Nuffield Trust thinktank, said: “There is a danger the actions announced by the Secretary of State will worsen some of the patterns that got us into this mess. 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.
“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. They happen across England. Which trust is worst affected is often a matter of luck and history as much as leadership. We need a system that encourages leaders to go to the most difficult and challenged trusts to improve patient care, not one that rewards them for choosing easier places to work.”
The plan is a partial resurrection of the “name and shame” policies of former health secretary Alan Milburn who introduced them as part of Tony Blair ’s government in 2001. He was recently appointed by Mr Streeting to a senior advisory position in the Department of Health. Mr Milburn’s earlier reforms also allowed some hospitals to have greater financial and operational independence and increased NHS outsourcing to the private sector. In his time out of government he has worked as an adviser to private healthcare firms.
Matthew Taylor, chief executive of the NHS Confederation, which represents NHS trusts, said: "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. We look forward to working with the government to make sure that any new measures don’t disincentivise managers from taking on roles in struggling organisations.”
Dean Rogers, executive director for the Society of Radiographers, said “there is no question that the NHS has hospitals that are failing” but added: “There is very little evidence to show that naming and shaming trusts would address this. Evidence in education shows that this kind of approach instead leads to unsustainable pressure, more burnout and little evidence of higher standards or greater efficiency.”
Under the plans "turnaround teams" will be sent into struggling trusts, while top performers will have more freedom over spending. 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 had already announced that failing NHS managers will be denied pay rises if they do not improve patient care.