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What happens when your trust is taken over?

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Poorly performing trusts are increasingly likely to be taken over by more successful trusts or private management. Helen Mooney reports

The Healthcare Commission last month published its annual health check for NHS trusts in England – the yardstick by which success or failure is measured.

In many areas, trusts are improving both quality of care and use of resources.

However, six trusts stood out for the wrong reasons, scoring ‘double weak’ for both use of resources and quality of services (see below)

NHS trusts that were rated ‘double weak’ in the annual health check

  • Scarborough and North East Yorkshire Healthcare

  • North Yorkshire and York PCT

  • Great Yarmouth and Waveney PCT

  • Royal National Orthopaedic Hospital, Middlesex

  • East of England Ambulance Service

  • Brent Teaching PCT, London

Health secretary Alan Johnson demanded explanations. Representatives from the six trusts were called in to meet with his officials at the Department of Health’s London headquarters, Richmond House.

If improvements are not seen, these trusts could find themselves the first to be dealt with under the government’s new Regime for Unsustainable NHS Providers. Now going through consultation, this is due to be implemented in 2009–2010. Under this regime, failing management teams can be replaced.

The regime follows a warning first made in January that staff at failing trusts could find themselves under the management of their more successful neighbours.

‘Later this year, I want to spell out in more detail what steps we should take to remove underperforming hospital management, enabling successful trusts to take over failing hospitals to turn around their performance,’ Mr Johnson said in a speech to trust chairpersons.

This was duly followed up in June by a first-stage document entitled Developing the NHS performance regime, which expanded on Mr Johnson’s words and, for the first time, suggested that managers from the independent sector might be brought in to turn round trusts.

The Regime for Unsustainable NHS Providers will set out what will happen to NHS trusts that continue to fail.

The Department of Health has admitted that, in the past, failing NHS trusts have been dealt with in what it called a ‘relatively ad hoc way’. It said that the regime will provide a ‘backstop of what ultimately happens if all previous turnaround efforts fail’.
It seems inevitable that some trusts will be merged or taken over, most probably by foundation trusts.

So how exactly will this affect frontline nurses?

For clinical staff, the key concerns are likely to be job security, coupled with a continuity of both care and services provided.
The regime consultation paper states that it will aim to ‘protect patients and staff from failing services and ensure good local services for all patients and service continuity even in the event of organisational failure.

‘This regime will support staff in providing high-quality care to patients and will help to improve staff morale,’ it adds.

Karen Didovich, senior employment relations adviser at the RCN, said nurses should not be concerned about changes to terms and conditions.

‘Employment conditions will be covered by TUPE, so the employment contracts of staff won’t change – the significant thing is the structural change,’ she said.

However, she suggested morale was bound to suffer – at least initially. ‘As soon as there is a sign that a trust has been labelled negatively, the motivation and morale of staff go downhill,’ she said.

This is not the first time that the government has tried management takeovers. Two trusts have already acted as guinea pigs.

Last year, Good Hope Hospital NHS Trust in Birmingham was taken over by Heart of England NHS Foundation Trust and the mental health services of Shropshire PCT were subsumed by South Staffordshire and Shropshire Healthcare NHS Foundation Trust.

Mark Radford, a consultant nurse in emergency surgery at the Heart of England trust, worked at Good Hope before the merger and is still based there.

‘The merger was the only real option and it has given staff and patients a great deal of opportunities. From my point of view, it has made a real difference,’ he said.

However, he admitted that there was a lot of ‘anxiety and tension’. ‘Because a number of services would be duplicated, people naturally assumed there would be redundancies,’ he said.

Mr Radford, who was also Good Hope Hospital trust’s associate director of nursing prior to the merger, said dealing with anxiety among nursing staff was often demanding.

‘Sometimes it was quite difficult to manage because there was a lot of rumour and speculation. It was key to try and get through to staff and to be honest with them about what we knew,’ he said.

But Wendy Brewer, a Good Hope theatre nurse and Unison regional branch secretary, said that, although the senior management at the Heart of England trust were ‘very open about the merger process’ and worked closely with unions, it was still a ‘very sad time’.

‘Staff morale [at Good Hope] has been very low. Staff have been very concerned about job losses and about moving their workplace, as this could involve a lot of extra travelling between sites,’ she said.

However, Ms Brewer agreed that things were starting to get better. ‘The aesthetics and the environment of the hospital have improved greatly and gradually staff are beginning to feel the benefits of the merger’, she said.

Gill Foster, a nurse and service manager at South Staffordshire and Shropshire Healthcare NHS Foundation Trust, who worked for the provider arm of Shropshire PCT before its merger, was positive.

‘The merger has refocused attention on developing clinical leadership and improving clinical outcomes for service users,’ she said. ‘Nurses feel listened to and are given greater opportunities for development and some shining stars are emerging.’

It remains to be seen what will happen to the six ‘double weak’ trusts. A Department of Health spokesperson said that they had held discussions with senior DH officials, NHS chief executive David Nicholson and their SHA chief executive.

By 23 October these trusts, along with 27 others deemed to be weak in quality or financial performance, were expected to have drafted action plans.

‘Action plans will be monitored by the SHA and progress will form part of the performance management discussions between the SHA and DH,’ the spokesperson said.

She warned: ‘The DH, with the SHA, will be more closely involved in the monitoring of progress of serial “weak” organisations.

From April 2009, those weak organisations failing to demonstrate improvement will also be subjected to intervention under the NHS performance regime.’

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