HSJ Channel, Insight and Influence: Not all it seems: The success regime has teeth

In December 2014 Simon Stevens, chief executive of NHS England, announced plans to work with Monitor and the NHS Trust Development Authority to take charge of struggling health economies and move them to new models of care as outlined in the organisation’s NHS Five Year Forward View.

This would be done through the newly established “success regime”.

This approach is a stark contrast to the traditional role of a regulator which was seen by many as to micro manage a failing service to the point of destruction and impose its own punitive “failure regime”.

The shift from a system of failure to success is more than just semantics.

NHS providers will be hopeful that it indicates a more helpful and solution based method of regulation, rather than one that seeks blame and serves only to cast a looming shadow over an already pressured provider.

The first effective takeovers

It was announced last week that three entire regions of England – Essex, north Cumbria, and northern, eastern and western Devon – would be made subject of this regime after it was determined that the hospitals in these areas were failing.

This move signifies the first time that an effective takeover across multiple trusts, spread over entire regions, has taken place. The idea of a “success regime” is a much more appealing prospect than what came before it.

The new regime would, in theory, strive to implement measures to make good system-wide failures and the variety of deeply embedded issues that can create serious problems in hospitals (i.e. staff shortages and inefficiency through the allocation of finances).

It appears to be a friendlier beast than the rather daunting consequences of special measures, the mere name of which carries with it a stigma that implicates an inability to meet basic standards.

A simple internet search of the term “success regime” is telling.

Results are split 50:50 with independent news sites reporting the story of the three regions subject to NHS England’s action in a journalistically matter of fact fashion, and the remaining government run sites gleefully hailing that the regions are to “benefit” from the regime. It is clear that this is being sold as a gift. A helping hand. The proof however, will be in the pudding.

A holistic diagnosis

So how will this work? The aim of the success regime will be to put in place the conditions for future success. The new approach will involve the whole system of an area, including community based services, social care services and GPs.

Mr Stevens has spoken recently of the “holistic diagnosis” of these areas.

He said in a speech to health managers in Liverpool: “Instead of just looking at how the hospital is doing in isolation, we have to look at everything that is available. The idea here is that we are going to collectively, both locally and nationally, bring the full range of flexibilities and say, ‘What is our holistic diagnosis as to what needs to change? It recognises that we get the fact that the existing models of trying to sort some of these knotty problems out need to evolve”.

The approach makes sense and indicates a logical and positive step, however, there are concerns attached to the methodology.

Whilst Mr Stevens has attempted to persuade providers that the regime will not constitute a takeover, many worry that the implementation of staff from NHS England, Monitor and the TDA to work alongside local managers in these areas will cause confusion and inconsistency.

If the regime is to work it is vital that only the most expert of representatives from the three national bodies be tasked with effectively collaborating with existing managers.

If the purpose of the success regime is to work together to create solutions, every stakeholder must be able to deduce what the most effective solution will be and how best to implement that solution.

The concern is that too many cooks may indeed further spoil an already sour broth.

In addition, regions subject to the success regime will not necessarily know how long they will be “shadowed” by the coordinated, external helpers.

Slow and steady wins the race

In realistic terms, if the regime’s aim is to unpick and resolve deeply seated issues, the task will undoubtedly be long term. NHS England’s proposal is to completely transform how services are delivered and this will undoubtedly be a marathon rather than a sprint.

Previous regimes have focussed on short term fixes, such as dispensing with the incumbent trust chief executive, but this does not resolve underlying issues that affect the success of a hospital. Failing to meet targets in treating accident and emergency patients, for example, cannot be attributed to an individual. It is time to look at the bigger picture.

There is no question that the success regime is a more positive and holistic way to approach a service that is falling short – but do not be fooled by the language. The friendly, cooperative, “don’t worry we’re here now” packaging still harbours three organisations, with teeth, that all want a say in how a service, nay, an entire region of services, is run.

The implication of this input is a serious change in the way that services are run day to day.

There will be a significant change in the profile of staff on the ground as third party “helpers” enter a service. In addition, there will be a period of flux during which local managers have to determine who it is that they should be listening to and whose voice (of the three organisations) is the most important.

In an ideal world there is a joined up, completely agreed approach and problems are resolved in a timely fashion. However, this is not an ideal world.

A perception of failure

We must not lose sight of the fact that demand on the NHS is rising at a time when the government continues to relentlessly pursue efficiencies.

The level of intervention involved in the success regime will only increase while the government fails to resolve inadequate NHS funding.

The public are privy to the problems faced by the NHS and this is not aided by daily news reports of yet another trust that has been put into special measures. This results in the perception that the NHS is failing.

It is this author’s rather cynical view that the government is doing some damage limitation and is rebranding how it deals with hospitals that do not make the grade. Making examples of these services has not worked; it has not cured our “ailing” NHS. So instead, we will be persuaded that the government is parachuting in the sector’s brightest stars to help bear the load and plan for the future.

The logistics of this are untold and the implications for people on the ground are untested but the public will not be troubled with this detail. Instead, they will sleep soundly at night knowing that their paternal, reasonable and caring government has stepped in to save the day.

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