05 October 2001
Last week the Department of Health published performance indicators for trusts in England, giving them between zero and three stars.
It promised greater central control of the 12 trusts given no stars and threatened to sack their chief executives if improvements were not made in areas such as cleanliness and waiting lists.
In six of the failing trusts the chief executive had been in post fewer than 18 months – they have been given a year to improve performance.
The remaining six, where the chief executive has been in the post longer, have three months to respond.
Robin Douglas, director of organisational management at the Office for Public Management, said poor performance in some of the trusts was due to historical factors. These included merger plans that had been in the pipeline for a number of years, preventing redevelopment and refurbishment.
Ministers should take a broader view. He said: 'You have to question in which direction the trust is going. In education, assessments have evolved so they measure the degree to which people have shifted and I think something similar will happen in health.'
But he added that chief executives should face sanctions if no progress was made. 'I think the three months symbolise a period in which people can at least demonstrate they are prepared to grapple with the change agenda. I am hearing that one or two places are sticking to their current position which is "this is not fair. We are making progress: you don't understand us". If a hospital is failing right across the board it is difficult to support this argument.'
But the King's Fund doubts that closer management of failing trusts would be effective.
John Appleby, its director of health systems, said: 'It may be better for the government to encourage more local flexibility across the board – to produce fewer national targets for NHS managers, allowing them to innovate and engage more closely with the public to find out what they want from their local NHS.'
PFoct2001
