What to do about failing NHS organisations

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 …