Wes Streeting will today issue a stark warning to NHS leaders at underperforming hospitals, telling them there will be “no more rewards for failure” as he unveils new reforms aimed at driving accountability and improving patient care.
Addressing the NHS Providers conference in Liverpool, the Health Secretary will today outline a series of measures designed to tackle poor performance within NHS trusts, stating that managers who fail to deliver improvements will face pay freezes and possible dismissal.
He is expected to say: “The Budget showed this Government prioritises the NHS, providing the investment needed to rebuild the health service.
“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.
Mr Streeting’s comments indicate a tougher stance on NHS accountability as the government seeks to turn around failing hospitals.
Central to the government’s strategy is a comprehensive performance review of NHS trusts across England, which will be conducted by NHS England and published in regularly updated league tables.
This “no holds barred” review will assess hospitals on a range of criteria, including financial management, service delivery, patient access to care, and the competence of their leadership teams.
These tables are intended to provide transparency and public accountability, revealing both successes and shortcomings across the NHS. Underperforming hospitals will be publicly named and shamed, a measure Mr Streeting believes is required to force improvements.
However, while high performers will be granted increased spending autonomy to modernise their facilities, persistently failing managers will be replaced, with specialist “turnaround” teams brought in to manage under-resourced and poorly performing trusts.
Mr Streeting’s announcement has been greeted with a mixed response. Leaders within the NHS fear such punitive measures could have a demoralising effect on staff and could deter skilled managers from taking on roles in struggling trusts.
Saffron Cordery, deputy chief executive of NHS Providers, cautioned that the government’s focus on punitive accountability measures may overlook deeper systemic issues that require attention.
She highlighted a “huge” scale of challenges NHS leaders face, including workforce shortages, historic under-investment, and outdated infrastructure, which she argued are among the root causes of productivity issues. Ms Cordery added that addressing these underlying issues should be prioritised before focusing on league tables and dismissals.
Similarly, Matthew Taylor, chief executive of the NHS Confederation pointed out that league tables might strip away vital context, creating a distorted view of each trust’s performance.
He explained: “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.”
Additionally, some leaders argue that the new league tables and dismissal threats could worsen recruitment challenges.
Thea Stein, CEO of the Nuffield Trust, warned that making poor-performing trusts visible in league tables could dissuade skilled professionals from applying to work in these areas, which may exacerbate staffing shortages in the hardest-hit regions.
Ms Stein said: “We need a system that encourages leaders to go to the most difficult and challenged trusts to improve patient care, not one that rewards them for choosing easier places to work.”
She likewise emphasised that naming and shaming might only worsen an existing problem, especially in regions with complex socioeconomic challenges affecting patient outcomes and staff morale.
The government’s reforms extend beyond simply identifying failing hospitals; there is also a focus on financially rewarding NHS leaders who perform well. A new pay framework for senior NHS managers will be introduced by April 2024, allowing for financial incentives tied to measurable improvements in patient care and operational efficiency.
However, under the new system, managers who fail to meet standards will not receive pay rises, with Streeting making it clear that “rewards for failure” will no longer be tolerated.
In addition to focusing on leadership accountability, Mr Streeting’s proposals target staffing practices to reduce NHS reliance on agency workers.
NHS trusts currently spend about £3 billion a year on temporary staffing, which Mr Streeting aims to reduce by limiting trusts’ ability to hire agency staff to fill gaps, including positions for healthcare assistants and cleaners.
NHS staff who leave permanent roles may also face restrictions on re-entering the NHS through agencies, a policy intended to encourage staff retention and reduce costs associated with temporary employment.
The Department of Health has also introduced measures to create more incentives for financial efficiency within the NHS. Currently, trusts that run budget surpluses are unable to retain the extra funds, reducing the motivation for hospitals to manage their finances tightly. Under the new plan, however, high-performing trusts will be able to retain a portion of any surplus funds they generate, giving them more control over spending and investment in infrastructure, equipment, and technology.
Rachel Power, chief executive of the Patients’ Association, has welcomed the government’s focus on addressing poor performance and rewarding excellence, seeing it as a step towards raising standards across the NHS.
However, despite some backing for the plan’s objectives, NHS leaders and advocacy groups remain concerned about the potential for unintended consequences. They argue that without addressing the core issues that drive poor performance – such as workforce shortages, infrastructure decay, and socioeconomic factors affecting patient populations league tables and punitive measures may not produce the desired improvements.
