Why the NHS must learn to fail successfully

The NHS has always struggled with failure. When a trust gets into trouble proposed solutions run quickly into the ground with incompetent managers, intransigent clinicians, unrealistic patients, dissembling politicians, interfering regulators or out of touch system leaders blamed in turn. A sticking plaster is applied, the problems downplayed – only for some to explode in scandal and a this-must-never-happen-again inquiry.

‘Mid Staffordshire’s sad, inevitable downfall has resulted in a process which is hugely costly and time consuming’

The creation of theoretically independent foundation trusts first shone the spotlight on failure at the start of the last decade and so failure has been seen as a symptom of the internal market reforms. However, the truth is the NHS has always agonised over how to deal with poor services in an effective, timely and transparent manner.

What really changed in the early 2000s was the sensible recognition that the problem needed a definitive solution – and so began the quest for an effective “failure regime”. More than a decade later we are still looking.

The tensions unmasked over the placing of Barking, Havering and Redbridge University Hospitals Trust into special measures reveals a system still wrestling with the best way to deal with deficiency. The attempt to resolve the fate of South London Healthcare Trust ended in confusion, a successful legal challenge and a parliamentary row.

A better answer

Mid Staffordshire’s sad, inevitable downfall has resulted in a process which is hugely costly and time consuming. There is little enthusiasm among anyone in a position of influence for it to be repeated soon.

‘Sustainable solutions to failing trusts are likely to involve re-engineering a significant part of a health economy’

So what happens next? More money will not be the answer in most cases. Yes, extra funds to create more appropriate service models would be very useful – but public resources should not be wasted in the pretence that ineffective, outdated, poorly located or even dangerous services have a future.

Any sustainable solution must reconcile two often opposing challenges; the need to move relatively quickly before the problems change and the proposed solution becomes irrelevant; and the fact sustainable solutions to failing trusts are likely to involve re-engineering a significant part of a health economy.

Work on both is taking place with the Department of Health, NHS Trust Development Authority and Monitor – with NHS England pitching in. HSJ’s analysis of trust finances show how urgently they need to come up with a better answer to what happens when NHS organisations fail.