Foundation trusts were rocked by the suspension of the Tariff and its aftermath as a result of which the foundation trust authorisation programme that is one of the critical planks of system reform has been delayed. These time-table changes may seem small to anyone other than the NHS trusts affected but they are a symptom of the mounting concern that many providers in the NHS feel about the reform programme, despite welcome recent attempts by the Department of Health strategy team to bring a clearer framework to bear on system change.
The Department of Health has rightly demanded that foundation trusts operate on a business-like and efficient basis. The Monitor authorisation tests the ability of NHS trusts to make this step change in performance. It assesses the business planning and risk management capacity of organisations as well as the governance framework and the skills composition of boards to operate corporately, oversee strategy and performance and to be accountable to governors and members. Monitor's risk ratings show that the majority of foundation trusts are doing well and continuing to improve their corporate governance and financial management. This represents a real raising of the game of public sector providers.
System reform should be creating a new deal between the Department of Health, the NHS and its providers. Just as the NHS has high expectations of its providers to deliver, providers should be able to have confidence that the wider system change programme has a clear direction and framework, with the expertise and resources in place to drive the reform agenda without inadvertently undermining it.
The service is trying to introduce many diverse elements of a huge change programme in a very short time. We understand the scale and complexity of the task and foundation trusts remain committed to the reforms. However, if they are to work, the change process needs focused, consistent leadership that challenges players to perform but builds trust amongst them. It does not need shocks that create fear even in efficient organisations that, despite their best efforts, they may not be able to achieve a sustainable future, let alone innovate to improve health.
The tariff debacle is a wake up call for a step change in performance from all parties. On their part, foundation trusts now have expectations of the way in which the department must act if the new system is to deliver. One of these expectations is that the tariff setting process must become far more robust and transparent to give confidence to all stakeholders in health. Foundation trusts ideally want to see the tariff set independent of government, but the demand for next year is that, at a minimum, there must be a properly transparent process with:
- A published time-table and work plan
- Clarity about the parameters for major issues of principle
- Proper stakeholder consultation time-tabled into the process
- Major changes modelled on agreed scenarios to understand the likely impacts of change
- Sufficient time for providers to absorb major funding changes
- Clear, transparent outcomes
Quick action on the part of government is needed if we are to maintain the momentum of the reform programme. A commitment to overhaul the tariff setting process could send a clear signal that the Department of Health understands its exhortations to providers must be matched by a responsibility to create the framework for success.
Health Service Journal - 9th March, 2006
