Observations The Best Policy

What to do about failing NHS organisations

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6972 (Published 31 December 2015) Cite this as: BMJ 2015;351:h6972
  1. Nigel Edwards, chief executive
  1. 1Nuffield Trust, London
  1. nigel.edwards{at}nuffieldtrust.org.uk

Give clinicians power to make continuous improvement

Deficits in NHS hospital trusts are now so substantial and widespread that the problems must be with the system rather than mismanagement at trust level. In recognition, the chancellor of the exchequer’s spending review last month created a new fund for the NHS in England of £2.14bn (€2.9bn; $3.2bn) for 2016-17, with £1.8bn to “stabilise NHS operational performance”—that is, for deficits.

Policy makers have tried unsuccessfully to develop a coherent approach to failing NHS organisations for more than a decade. The former health secretary Alan Milburn tried “franchising” (in essence, replacing the chief executive). Others tried turnaround teams, specialist administrators, special measures, contingency planning teams, “buddying” with other trusts, the private sector management of Hinchingbrooke Hospital, and mergers and takeovers.

Such interventions …

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