Analysis: Franchising hospitals

Will management changes help failing hospitals

Chief executives at four failing hospitals - all in the south of England - are to be replaced.

The government is hopeful that "high-fliers" from successful NHS trusts will take up the challenge of turning them around.

The idea is similar to the concept of the "superhead", sent into a failing school as a final attempt to avoid closing it down altogether.

However, there are plenty of detractors who say that changing the management team will only work if bad management is the problem.

Star ratings

All four of the hospitals involved received no stars in a recent ratings system.

The stars system is complex - based on performance against dozens of government targets.

These cover everything from the cleanliness of the hospital, to death rates following surgery and the number of people waiting for hours on trolleys in A&E.

Health Secretary Alan Milburn is convinced that replacing managers will bring about long-term improvement.

He said: "Good management makes or breaks any organisation. In the NHS we have some brilliant managers. I want every part of the NHS to benefit from the best managerial talent in the land. Staff and patients deserve no less."

However, Nigel Edwards, from the NHS Confederation, believes that the situation is more complex.

Good management makes or breaks any organisation

Alan Milburn

If there is an underlying problem at a hospital - perhaps bed-blocking because of poor social services assistance in the local community - then a new broom might not be able to sweep clean.

He told the BBC: "It may be that changing management will have the right effect - but it could be that problems are deeper and more systemic.

"You have got to get the diagnosis right before you start treatment. If there are other, deeper problems, we will probably be back here talking about this in a year's, or two years' time."

Hospitals which gained three stars in the government's rating system will get extra money - and the freedom to spend it as they please.

You have got to get the diagnosis right before you start treatment

Nigel Edwards, NHS Confederation

They can even simply give their staff a pay rise with it.

However, the failing hospitals like the four named today have no such freedoms.

While there will be extra money available, its use will be strictly regulated.

These are not true franchises at the moment - bidding for the jobs is limited to other NHS managers, rather than earlier suggestions that private sector firms might be able to compete for the jobs.

Nevertheless, many see this step as a step towards this eventual aim.

Pressure group London Health Emergency warned that the hospitals were being "softened up for eventual takeover" by the private sector.

It said the announcement was "a staging post towards the eventual aim of bringing in private companies like Arthur Anderson".

Whether many private firms would be easily persuaded to take the plunge into the emotive and complex world of the NHS is another matter.