03 August 2001
Ministerial speeches have suggested that top-performing trusts may be invited to bid for the franchises to run 'failing' hospitals. But it is now becoming clear that intervention is just one part of an important franchising experiment aimed at putting the service's top managers where they are most needed.
In a document spelling out the structural reforms, the DoH said that franchising 'will include matching top managers to the biggest challenges, ensuring top managers support development and performance improvement in other NHS organisations and drawing together intervention teams to turn around failing NHS bodies'.
The document, Shifting the balance of power within the NHS, concentrates on the creation of new strategic health authorities (SHAs) and the abolition of the department's regional offices.
NHS chief executive Nigel Crisp has already indicated that a cadre of some 35 top chief executives capable of running the new strategic bodies will be identified. The document says that these candidates will be invited to prepare franchise plans, including proposals for the structure and competencies of their senior management team.
Candidates will be able to bid for more than one franchise. In a major change on performance management, successful chief executives will be judged against their own franchise plans.
Revenue allocations will be made direct to primary care trusts and not to strategic health authorities, and work is under way to devise a formula to allocate fairly to small populations. PCTs and NHS trusts will also receive direct capital allocations.
While regional offices are to be 'abolished', four new regional directors of health and social care will be appointed, linking the NHS with the Department of Health. 'They seem to have reinvented a new intermediate tier,' said Nigel Edwards, policy director of the NHS Confederation.
Behind the scenes, ministers seem to accept that the expected £100m savings from the restructuring will come from freeing buildings and other such capital resources.
PFaug2001
