News / HFMA FT Conference: Failure regime is blunt instrument for reform

The unsustainable providers regime (UPR) is a ‘blunt instrument’ and its use should be avoided if at all possible, according to the managers responsible for leading the failure regime process at South London Healthcare NHS Trust.

Matthew Kershaw (pictured), trust special administrator (TSA) at South London, and Hannah Farrar, strategic adviser to the TSA, told the HFMA foundation trust conference that the process had a collateral impact on relationships and leadership. Ms Farrar said she had heard people wishing for the UPR to ‘help focus minds’ in their own health economies. ‘I wouldn’t wish for UPR,’ she said. ‘It is best to avoid it if possible.’

Instead organisations should work together voluntarily across health economies to understand how services can be provided sustainably for the long term and look to build consensus for the changes.

Both speakers highlighted the incredibly tight time scales imposed on the work. They were given 75 days from the launch of the regime in July 2012 to produce the initial report and recommendations, which were then subject to consultation. These were then finalised in January with the health secretary accepting the proposals with some minor changes in February. ‘All this could have been done without the regime,’ said Ms Farrar. ‘What the regime basically does is require pace and shorten the consultation.’

Ms Farrar described the pace of the review as ‘gruelling’. ‘However it shows how the NHS can do analysis and planning in a tight time frame,’ she said. ‘This has often taken years in the past.’

The UPR was initiated after South London trust racked up accumulated deficits of over £350m by the end of 2012/13. With a ‘no change’ approach estimated to generate further significant deficits, the review looked to identify options for the sustainable delivery of services for the local population. Four recommendations focused on productivity improvements, changes at one site, wider estates reform and the need for PFI support.

However,  these recommendations would still have left the trust in deficit, so further recommendations sought to close the gap. These involved changes that spread outside of the South London trust, requiring service reconfiguration of the neighbouring Lewisham NHS Trust and some savings from mergers. The proposed changes at Lewisham – re-establishing it as an elective centre with urgent care, but no emergency admissions – were the most controversial elements of the programme.  The decision to make recommendations that impacted on other organisations was one of the issues behind a judicial review, which was taking place at the same time as the HFMA conference. Opponents to the changes in Lewisham claimed the TSA had exceeded its remit and powers.

Ms Farrar said the regime created ‘massive momentum for decision making’. ‘But it has not created the same momentum for  implementation,’ she said. ‘We have to think about how to create pace for change as well as decision making. Both managers recognised the difficult job of implementation that still needed to be taken forward.

But Mr Kershaw said it was right to separate out the review and recommendations from the job of implementation. ‘We were asked to identify the issues and recommend a way forward,’ he said. ‘If we’d been told to implement as well it would have been more difficult. [By separating the different stages] we had no vested interest.’