Intended for healthcare professionals


Turning around NHS deficits

BMJ 2006; 332 doi: (Published 19 January 2006) Cite this as: BMJ 2006;332:131

NHS deficits and turnaround teams – Every little helps

Dear Editor,

The editorial (1) by Chris Ham is timely and relevant as there has
been considerable media and public interest in the current financial
health of the NHS and the government has announced how it will be tackling
the issue.
Ham poses an interesting question “whether the private sector will succeed
where the NHS has failed remains to be seen”. Turn around teams (TATs) are
not a new phenomenon in the NHS. For example, the NHS clinical governance
support team has developed a framework (2) based on organisation theory
incorporating the “everyday experience” of frontline staff and implemented
this framework as a part of organisational turnaround interventions to
support zero star organisations. The difference this time of the current
TATs is that they are addressing a specific failure – inability to achieve
financial balance. NHS public enquires over the years have identified (2)
five explanations for failure: inadequate leadership, systems and process
failure, isolation, poor communication and disempowerment of staff and
service users.

What does previous research show? Fulop (3) undertook a study funded
by the NHS confederation to identify the markers for failure and the
approaches used to turn around NHS organisations. Fulop’s conclusions
might be relevant in the new era of private sector driven turnarounds.
According to Fulop (3) “organisational turnaround in complex health care
organisations takes time, possibly longer than in non-professionally
dominated organisations, and its sustainability in the long term is

The Finance Director at the Department of Health has just submitted
his report to the Secretary of State for Health on the financial
turnaround in the NHS (4). In the report he has summarised the conclusions
of the TATs. For some organisations these are “1) the capability of the
management was inadequate to deal with the challenges of their current
financial position 2) the quality of information would impede the
turnaround process 3) In some cases the Strategic Health Authorities were
allowing unproductive behaviour between trusts and PCTs”. This may imply
that any help and support to the management team would be helpful in their
efforts to achieve financial balance. The TATs have also graded the
clinical and operational issues of the visited NHS organisations using a
traffic lighting system as Red, green and amber.

It is hard to tell whether TATs will succeed in professionally
dominated complex health care organisation with competing sub-cultures.
However our local experience (5) already shows that when TATs identify
good practice and provides feedback this lifts up the morale of NHS
managers and frontline staff as has happened in our own organisation.
According to the newspaper item (5) “The Suffolk West PCT received the
highest possible ranking from a management consultancy turnaround team
which was scrutinising the finances of the cash strapped body. The report
concluded the PCT has a ‘robust and effective’ financial recovery process
that is delivering the plan and does not need external support”.


1.Hewitt Announces Action To Turnaround NHS Finances. DH
pressrelease, 25th January 2006.
Last accessed 27th January 2006.

2.Glanfield P, Bevington J, Appleton L. Getting to the heart of what
matters. Page 20-23.
december2004.pdf Last accessed on 27th January 2006.

3.Fulop N. Organisational turnaround. Lessons from a study of
‘failing’ health care providers in England.
-%20abstract.pdf Last accessed on 27th January 2006.

4.Financial turnaround in the NHS. Department of Health. Last accessed on
27th January 2006.

5.Top score for health trust. Suffolk west PCT has a ‘robust and
efficient’ financial recovery process. East Anglian Daily Times, Saturday,
December 24, 2005.

Consultant in Public Health

Dr.Peter M Bradley
Director of Public Health

Suffolk West PCT,
Thingoe House, Cotton Lane,
Bury St Edmunds, Suffolk IP33 1YJ

Competing interests:
The authors are employed by a PCT, which is in financial deficit and was visited by a turnaround team in December 2005, which reported the PCT’s position.

Competing interests: No competing interests

27 January 2006
Padmanabhan Badrinath
Consultant in Public Health
Peter M Bradley
IP33 1YJ