Failing Hospital Trusts to Be ‘Named and Shamed’ in League Tables

Britain's Health Secretary Wes Streeting leaves after attending a weekly Cabinet meeting at 10 Downing Street in London on Oct. 8, 2024. Henry Nicholls/AFP via Getty Images

Failing hospitals will be named and shamed in league tables and NHS managers sacked if they cannot demonstrate improved patient care and greater control of finances, the government has said.

Health Secretary Wes Streeting was expected to tell leaders at an NHS Providers conference in Liverpool that there “will be no more rewards for failure” as he sets out a package of measures aimed at tackling poor performance.

NHS England is proposing to carry out a “no holds barred” performance review across England with the results made public in league tables which are regularly updated, in a similar way to school league tables.

NHS trusts can expect to be ranked on a range of indicators such as finances, delivery of services, patient access to care and the competency of leadership.

But some health leaders hit back at the move, saying it could demoralise staff and that belief in a “magic productivity tree” is no different to belief in a “magic money tree.”

‘Manage People Out’

Speaking on Wednesday, Streeting told BBC Radio 4’s “Today” programme that “where we have poorly performing senior managers, I’ll make no apology for managing those people out, because people know, and this is the guilty secret of the NHS, there are very senior managers who are paid on average let’s not forget £145,000 a year, who are managed out, given a pay-off in one trust and then reincarnate in another NHS trust.”

Under the government plans, persistently failing managers will be replaced and turnaround teams sent into trusts that are running big financial deficits or found to be offering patients a poor service.

In contrast, the best-ranked NHS performers will be given greater spending control to help modernise their buildings, equipment and technology.

The Department of Health said there is currently little incentive for trusts to run budget surpluses as NHS trusts are unable to benefit from them, but that will now change, with top-performing trusts given more of this cash.

In the Budget earlier this month, the government pledged an extra a £22.6 billion in the day-to-day health budget and a £3.1bn increase in the NHS capital budget over the next two years.

Waiting Times Pledge

Streeting said: “Today we are announcing the reforms to make sure every penny of extra investment is well spent and cuts waiting times for patients.

“There’ll be no more turning a blind eye to failure. We will drive the health service to improve, so patients get more out of it for what taxpayers put in.

“Our health service must attract top talent, be far more transparent to the public who pay for it, and run as efficiently as global businesses.

“With the combination of investment and reform, we will turn the NHS around and cut waiting times from 18 months to 18 weeks.”

NHS Chief Executive Amanda Pritchard said: “While NHS leaders welcome accountability, it is critical that responsibility comes with the necessary support and development.

“The extensive package of reforms, developed together with government, will empower all leaders working in the NHS and it will give them the tools they need to provide the best possible services for our patients.”

Streeting has already announced that failing NHS managers will be denied pay rises if they do not improve patient care or get their finances in order.

A new pay framework for very senior managers will be published before April next year, with those who do well given financial rewards.

League Table Limitations

Matthew Taylor, chief executive of the NHS Confederation, said that the prospect of more league tables will concern health leaders, as these can strip out “important underlying information,” such as health inequalities across the regions.

He said: “NHS staff are doing their very best for patients under very challenging circumstances and we do not want them feeling like they are being named and shamed.

“League tables in themselves do not lead to improvement. Trusts struggling with consistent performance issues, some of which reflect contextual issues such as underlying population heath and staff shortages, need to be identified and supported in order to recover.”

The chief executive of the independent think tank, Nuffield Trust Thea Stein, said: “We know from the special measures for quality regime that naming and shaming NHS trusts can make it harder to recruit staff, which doesn’t help patient care at all.

“It’s unclear what new league tables will measure. A table based on general waiting times doesn’t add much if you need to know how good heart surgery is…

“Ministers have long warned the NHS against the naive belief in the magic money tree.

“But they themselves are at risk of falling for the appealing notion of a magic productivity tree which will make the NHS more efficient just by shaking the magic tree harder, rather than by changing the drivers of efficiency.

“That can only lead to the NHS being forced back into asking for ‘more, more, more’, with patients ultimately paying the price.”

Streeting was also expected to tell the conference that NHS trusts could be banned from using agencies to cover staffing gaps such as healthcare assistants and cleaners, in a bid to cut the £3 billion a year spent on agency workers.

Those NHS staff who leave permanent jobs could also be stopped from coming back into the health service through expensive agencies under the latest proposals.