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banner Monday, 18 February, 2002, 10:37 GMT
Quality drive
Because we trust the people on the frontline, the centre will do only what it needs to do; then there will be maximum devolution of power to local doctors and other health professionals

Since the inception of the NHS, there have been few ways of actually measuring how good individual parts of the NHS are.

Patients had no idea whether their hospital was performing well, or in the doldrums and dogged by poor management.

The government is introducing a series of reforms aimed at making hospitals far more accountable - and have made the job of health service management far more precarious in the process.

The NHS, like other public services, needs to be subject to independent scrutiny. Local people have the right to know how effective their local health services are.

The creation of the Commission for Health Improvement (CHI) was supposed to mean that every NHS Trust would be inspected at least once every four years. Health Secretary Alan Milburn announced in April 2002 that the work of CHI was to be taken over by a new super-regulator, the Commission for Healthcare Audit and Inspection.

The rolling programme of inspections is underway and appears to be on schedule - it has also made snap inspections into trusts where there are serious concerns.

Before it was replaced, CHI had already bared its teeth - in February 2002, Chase Farm and Barnet NHS Trust chief executive resigned following the discovery of serious failures during a routine inspection.

Government target: Performance Assessment Tables listing scores for every NHS trust and health authority in a variety of indicators, reflecting both management and clinical performance.

These "league tables" are now in their second year, with the second batch of figures due to be published in February 2002.

Nationally, the figures suggest improvements in many areas, but worsening performance in a few key indicators.

All NHS organisations will for the first time, annually and publicly, be classified as 'green', 'yellow' or 'red'.

This system has changed somewhat in the translate - so far, all NHS acute trusts have been given a rating, with stars awarded instead of the traffic light system.

A dozen hospitals were awarded no stars overall by the NHS in November 2001.

These were given three months to make improvements - and three quarters of them did so, said the Department of Health.

As a last resort, those organisations that exceptionally fail to respond to special measures and meet their recovery plan will be put under the control of a new replacement senior executive, non-executive, and clinical team

In February 2002, four out of the 12 "no-star" hospitals had not made sufficient progress.

In response, top management jobs at these trusts were put out to tender, with applications invited from managers from successful trusts.

It was initially suggested that other experts, perhaps from the private sector, could play a role, but they were not included in this round of franchising.

The NHS Plan says that failing trusts might end up being merged with other trusts, or split up where necessary.

The green-light NHS organisations will be rewarded with greater autonomy and national recognition.

In contrast the best-performing - or "three-star" hospital trusts will be given greater freedoms to do what they want.

Their share of extra money from the government's incentive fund is theirs to spend as they wish - it can even be used simply to give staff a pay rise.

The government says that management teams from "green light" - three star- hospitals will be able to take over the management of failing hospitals.

This is certainly what they are trying to encourage as the "franchises" for the four current failing hospitals are offered up.

This system of "earned autonomy" will be fully working by 2004, says the NHS Plan.

The government, by the same date, has pledged to spend less on management - and divert the funds to frontline care.

Whether they meet this particular target remains to be seen - in February, it was revealed that the number of administrators relative to NHS beds had actually increased to an all-time high in 2000.