Government announces package of 'tough NHS reforms'

Addressing the nation’s health leaders at the NHS Providers annual conference in Liverpool, The Health Secretary, Wes Streeting, outlined how "government and NHS leaders have a duty to patients and taxpayers to get the system working well and get better value for money".

NHS England will carry out a no holds barred sweeping review of NHS performance across the entire country, with providers to be placed into a league table. This will be made public and regularly updated to ensure leaders, policy makers and patients know which improvements need to be prioritised. 

Persistently failing managers will be replaced and turnaround teams of expert leaders will be deployed to help providers which are running big deficits or poor services for patients, offering them urgent, effective support so they can improve their service.

High-performing providers will be given greater freedom over funding and flexibility. There is little incentive across the system to run budget surpluses as providers cannot benefit from it. The reforms will reward top-performing providers and give them more capital and greater control over where to invest it in modernising their buildings, equipment and technology.

Health and Social Care Secretary,Wes Streeting, said: "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."

Amanda Pritchard, NHS Chief Executive, said: "While NHS leaders welcome accountability, it is critical that responsibility comes with the necessary support and development. The extensive package of reforms, developed together with government, will empower all leaders working in the NHS and it will give them the tools they need to provide the best possible services for our patients."

The NHS Oversight Framework, which sets out how Trusts and integrated care boards are best monitored, will be updated by the next financial year to ensure performance is properly scrutinised. Deep dives into poorly performing Trusts will be carried out by the government and NHS England to identify the most pressing issues and how they can be resolved.

Louise Ansari, Chief Executive of Healthwatch England, said: "People value the hard work of NHS staff, but it’s frustrating when services fail to operate effectively. So, a fresh approach to improving NHS performance is welcome. Currently, living in an area with either an outstanding or poorly performing NHS trust feels like a postcode lottery. When a service is underperforming, it often takes far too long for patients to see the necessary improvements.

"This is because the current system focuses on evaluating service performance based on the number of tasks it completes and it does not do enough to measure patients’ overall outcomes and experiences. Establishing a better system that encourages NHS managers to focus on delivering the best care as efficiently as possible, and leads to quicker changes at struggling Trusts, would be good news for everyone."

NHS senior managers who fail to make progress will also be ineligible for pay increases. There will be financial implications for very senior managers (VSMs) such as chief executives if they are failing to improve their trust’s performance, or letting patients down with poor levels of care. 

A new pay framework for VSMs will be published before April 2025. Senior leaders who are successfully improving performance will be rewarded, to ensure the NHS continues to develop and attract the best talent to the top positions. 

The changes are made in response to Lord Darzi’s investigation into the NHS, which found that: "The only criteria by which Trust chief executive pay is set is the turnover of the organisation. Neither the timeliness of access nor the quality of care are routinely factored into pay. This encourages organisations to grow their revenue rather than to improve operational performance."

Commenting on the announcement, the Nuffield Trust's Chief Executive, Thea Stein, said: “It is right that politicians are focused on extracting as much value as possible from the NHS at a time when taxpayers are being asked to dig deeper to fund public services and patients are feeling the pain of a health service under pressure. Finding ways to attract and retain top quality leaders, at the same time as clamping down on unnecessary waste in the system, are unarguable. 
 
“But there is a danger the actions announced by the Secretary of State will worsen some of the patterns that got us into this mess. We know from the special measures for quality regime that “naming and shaming” NHS trusts can make it harder to recruit staff, which doesn’t help patient care at all. It’s unclear what new league tables will measure – a table based on general waiting times doesn’t add much if you need to know how good heart surgery is. 
 
“Many of the drivers of poor productivity are systemic – from the dire state of social care stranding people in hospital, to crumbling roofs and worsening population health. They happen across England – which Trust is worst affected is often a matter of luck and history as much as leadership. 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.  
 
“Ministers have long warned the NHS against the naive belief in the magic money tree. But they themselves are at risk of falling for the appealing notion of a magic productivity tree which will make the NHS more efficient just by shaking the magic tree harder, rather than by changing the drivers of efficiency. That can only lead to the NHS being forced back into asking for ‘more, more, more’, with patients ultimately paying the price.”