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Failing hospitals should be taken over and not merged, says think tank

BMJ 2012; 345 doi: (Published 28 September 2012) Cite this as: BMJ 2012;345:e6601
  1. Adrian O’Dowd
  1. 1London

Poorly performing NHS hospitals in England should be taken over by either the private sector or the best foundation trusts rather than be allowed to merge, says a new report.

Clinicians will also have to be encouraged to take on more of a leadership role and be persuaded that a takeover can mean safer and higher quality care for patients and better working conditions for staff, it says.

The report is published by the independent think tank Reform and was coauthored by Paul Corrigan, who was a health adviser to the former prime minister Tony Blair.

Takeover: Tackling Failing NHS Hospitals says that the current favoured policy of merging failing NHS hospitals does not work, and it urges the government to recommend that some of the NHS hospitals identified as being in financial difficulty be taken over by private companies or the best NHS hospitals.1

In June the Department of Health said that 21 NHS hospitals were “clinically and financially unsustainable” and in need of restructuring. The Reform report estimates that between 20 and 30 hospitals were either failing or on the verge of failing.

By analysing case studies and published research, its authors concluded that past mergers of NHS organisations hadn’t worked. Forcing underperforming hospitals to merge with other underperforming hospitals only led to greater problems, they said.

The report backs up its arguments by citing the example of Circle, which earlier this year became the first private firm to take over the management of Hinchingbrooke Hospital, a failing NHS hospital in Cambridgeshire.2 The report says that the takeover led to the hospital achieving the highest patient satisfaction ratings in the region in its first six months, whereas a year ago it had the lowest, and to improvements in clinical performance. Outsourcing of the hospital’s management is an example of what the private sector could achieve if it were allowed to play a role in this process, the report adds.

The authors said that it was up to the government to create the conditions for successful takeovers by admitting that a significant number of hospitals were failing and ending the policy of merging failing hospitals with other failing hospitals.

The report argues that chains of hospitals run by the best NHS foundation trusts and private companies would develop centres of clinical excellence with “strong brands.”

Corrigan said, “Sooner or later the government is going to have to acknowledge both the clinical and economic case for radical change among NHS hospitals. The organisational turmoil of a takeover is a necessary part of change.”

The report acknowledges the significant turmoil that takeovers can represent for doctors, including changing their job plan, relocating, shifting the balance of power between senior doctors, and disrupting arrangements for education, training, and research.

“At face value it may look and feel to clinicians that they have much to lose from hospital takeovers,” it says.

Mike Farrar, chief executive of the NHS Confederation, which represents most NHS trusts, said, “We should use the expertise we have within the system to help address the financial challenges faced by local services. Addressing the problems some trusts are facing will require more than mergers and takeovers.”

The health minister Earl Howe said, “There isn’t a ‘one size fits all’ answer to this problem. Each NHS trust will need a tailored solution and different levels of support. In some cases that could involve private sector expertise, but in others the NHS itself will be the best solution.”


Cite this as: BMJ 2012;345:e6601


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