NHS centralism is in the small print

There is nothing alarming about a failure regime per se - it is a long overdue and necessary tool to ensure the effective running of services. What is worrying is the high and sustained failure rate contained in the paper, which has been signed off by health minister Ben Bradshaw.

Six deficit-ridden trusts appear slated for regime change. But instead of assuming that once the worst ones have been dispatched the overall performance of the NHS will improve, it maintains the assumption of a 2.1 per cent failure rate for the next 20 years. This amounts to 92 trusts.

The DH is now trying to backtrack, claiming the assumption is only for economic modelling purposes. But that does not square with the document itself, which describes the 2.1 per cent figure as conservative. This betrays little faith in the performance architecture the government has put in place to keep trusts out of trouble, notably foundation trust regulator Monitor.

Culling the herd

A failure regime has always been spoken of as something to be used only rarely, but this paper transforms it into a routine mechanism for killing trusts off - close to one every couple of months. This would gradually lead to a concentration of provider power, and a consequent atrophying of choice and competition.

Local accountability would also be undermined; with the failure regime dominated by the NHS chief executive and secretary of state, the consultations provided for are likely to be of little consequence.

The DH needs to spell out how it sees the failure regime operating and how it will address the fallout. Until it does so, managers could be forgiven for thinking it amounts to a mechanism for the widespread, centrally dictated reconfiguration of services.

Does the failure regime undermine local accountability? Email hsj.feedback@emap.com