NHS Confederation responds to performance regime vision document

Wednesday, 04 June, 2008

Nigel Edwards, policy director of the NHS Confederation which represents over 95% of NHS organisations and independent healthcare providers commented:

"We agree we need a clear approach to addressing poor performance and a clear failure regime. Where management is failing it must be addressed and the independent sector has a role to play. However, failure is often systemic rather than managerial and will only be solved by re-configuration and other strategies. We should not lose track of the fact the vast majority of NHS organisations are performing well - we need a balanced discussion."

He continued:

"For providers, we believe the diagnostic process to become a Foundation Trust should be at the centre of the approach. This will give a clear indication of the reason for failure but further diagnosis will be needed.

"In some cases poor management is the problem and new management is needed, in other cases there are intractable system issues like too many sites, the wrong buildings or over-provision. The situation is unmanageable and a different solution is needed.

"We need a tailored response which includes acquisition by a foundation trust, franchising by the independent sector or foundation trusts, or reconfiguration.

"Where poor management is the issue it must be addressed. Any player that is willing and able - including foundation trusts, talent in the NHS and the independent sector - could have a role to play in its solution.

"The fact that a trust has reached this point means that the challenges will be considerable for anyone. Foundation trusts and independent sector providers will be cautious about taking them on and in some cases may not feel able to without adequate incentives to run the service. The independent sector has shown that it can come up with different management and delivery models, so having them as an option is important.

"For managers, any issue of poor performance needs to be fairly and consistently managed and investigated with correct procedures. There is a new legal power due which will be for the secretary of state through the appointments commission to suspend and remove non executive directors and chairs. We support this new process."

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