Department of Health and Social Care
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Tough action against underperforming hospitals and trusts

Tough action against underperforming hospitals and trusts

DEPARTMENT OF HEALTH News Release issued by The Government News Network on 4 June 2008

Health Minister Ben Bradshaw today set out new plans to drive up standards of care and tackle underperformance in our hospitals and primary care trusts.

New measures set out in the vision document 'Developing the NHS Performance Regime' will identify failing trusts, remove poor managers and bring in new management, including from other hospitals or from the private sector.

Health Services Minister Ben Bradshaw said:

"The NHS has come a long way in the last ten years, with record investment, more clinical staff, shorter waiting times and better cancer and heart disease survival rates. But there are still unacceptable variations in performance and a small number of NHS organisations where performance is not meeting the standards which the public and patients expect. "

"As the Prime Minister made clear in his speech in January, we will not tolerate underperformance in the NHS and for the first time, we will publicly identify those trusts with poor safety and clinical records. This new guidance sets out how we will tackle poor performance and the turn-around regime which we are establishing for those hospitals and Primary Care Trusts identified as falling below minimum standards."

The new system means that:

* New minimum standards of quality, safety and financial management will be established and trusts failing to meet these criteria will be identified as 'challenged'

* The Chief Executive of the NHS will have responsibility for ensuring that all challenged trusts have agreed performance improvement plans with Strategic Health Authorities. These will have defined time periods and milestones against which improvement will be assessed

* Trusts unable to turn around their performance within the expected time period will be determined to have failed on quality, safety or financial grounds and the NHS Chief Executive will then have responsibility for over-seeing changes which can involve removing local management and bringing in a new management team from either other parts of the NHS, NHS Foundation Trusts or the private sector.

At the same time the Department of Health has set out insolvency principles for Foundation hospitals and non-Foundation Trusts designed to ensure that borrowing does not put NHS assets or the continuity of services at risk.

David Nicholson, Chief Executive of the NHS, said:

"There are already a number of good examples of how weaker performing trusts around the country have turned around their performance, but we want to ensure consistency and introduce a clearer and more transparent system. Our new vision sets out what constitutes underperformance and failure and will be a valuable tool to support NHS managers, Trusts and Health Authorities.

"It will also establish public accountability by helping patients and the public understand how well their local NHS is performing and what they should expect of it."

Professor Sir Bruce Keogh, NHS Medical Director, said:

"It's important for patients to know how safe their local hospital is and to feel confident in the competence and professionalism of the staff. Getting effective and meaningful performance measures is crucial.

"We are working with clinicians and managers to develop consensus and ensure the indicators help drive up standards and keep clinical and quality issues front and centre in how we measure performance in the NHS."

Further information about the details of the regime will be set out later this year:


1. The three main options open to the NHS for new management are:

* New NHS management, drawn from [the top management pool]

* NHS Foundation Trust management, deployed to the trusts through a merger of hospitals where an appropriate Foundation Trust is willing to take on this role

* Private Sector management, provided on the basis of a management contract, so that this will involve new management for the trust but no shift of NHS assets or staff to the private sector.

2. A further programme of work will be carried out to develop the detail of the vision and will be implemented as part of the 2008/09 Operating Framework.

3. Later this year we will publish the quality, safety and financial criteria on which underperformance and failure will be determined and how many trusts are not meeting them. Primary Care Trusts and hospitals will be judged against different but similarly challenging criteria.

4. In a speech to on 7 January 2008 at King's College London and the Florence Nightingale School of Nursing, the Prime Minister announced that 2008 would see the Secretary of State for Health set out "new and decisive action against failing services".

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