News Roundup [abridged Versions Appear In The Paper Journal]

Plan to put outside managers in NHS is criticised

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7334.384 (Published 16 February 2002) Cite this as: BMJ 2002;324:384
  1. Lynn Eaton
  1. BMJ

    Government plans to set up a register of non-NHS managers to run failing NHS trusts have been given short shrift by health service managers and the Institute of Directors—although some doctors believe the plans could work.

    Health secretary Alan Milburn announced his plans for a register when he named the four failing trusts that are to come under franchised management from April. These are Ashford and St Peter's Hospitals NHS Trust, Dartford and Gravesham NHS Trust, Portsmouth Hospitals NHS Trust, and Barnet and Chase Farm NHS Trust. However, management of this first round of trusts will go to the best NHS managers, not private sector ones.

    The register will include experts from the public, private, and voluntary sectors who are interested in turning round failing NHS bodies. They would be offered the work on a franchise basis for a fixed period and a predetermined fee. The four franchises already announced will be for three years, although details of who will do the job have not yet been announced.

    But Ruth Lea, head of policy at the Institute of Directors, doubted whether people from the private sector would even consider such a job.

    “You'd be running a failing trust, which is a big risk,” she said. “There is enormous responsibility and the risk of ending up in the press. There won't be the financial incentive for these people. And they are used to being accountable to shareholders. A lot of private sector managers would find the government targets very irksome.”

    On top of that, she added, they would find it difficult to manage an organisation where the lines of responsibility were not clear and where they didn't have control over the doctors.

    Meanwhile Dr Gill Morgan, a former public health director and now head of the NHS Confederation, argued that steps needed to be taken before an organisation failed, rather than calling in private managers when it was too late.

    “You need to be clear why organisations fail,” she said. “There are some significant failures where removing the senior manager is the right thing to do. For other organisational failures this is not the answer.”

    John Appleby, director of health systems at the King's Fund, agreed. “Would bringing in a new chief executive make a difference? Or do you need a new medical director, a new director of finance, or even a new chairperson?”

    But Professor Sir George Alberti, president of the Royal College of Physicians, felt the proposal could work.

    “Providing they have a reasonable feel for the public sector, they could make a fair go of it. They have to understand it is all about people—all about patients and all about professionals.

    “My one worry would be if they started going for the efficiency and finance side.”

    One manager from the private sector who has moved successfully into the NHS is Trevor Campbell Davis, chief executive of the Whittington Hospital, north London, who took up his job in April 2000. He had worked in the private sector for many years, running his own IT business and, before that, a publishing company. He had, though, been a non-executive member of a trust and health authority before moving into a staff job.

    “I don't think it is easy to come from the private sector to something as complex as the NHS,” he said. “You need to understand the language and the syntax. To be effective at senior executive level you really do need to understand the way the system works.”