In a sweeping package of NHS reforms unveiled this week, Health Secretary Wes Streeting has ignited a firestorm of controversy with his plan to introduce league tables ranking the best and worst performing hospitals across England. The proposal, part of Streeting’s vision to tackle what he calls the “guilty secret” of poor NHS management, has already drawn sharp criticism from medics and trust leaders who warn it could further demoralize an overstretched workforce struggling to cope with record demand.
Exposing the “Rotten Apples”
Defending his plans in a media blitz ahead of his landmark speech, Streeting pulled no punches in calling out what he sees as the NHS’s dirty laundry – underperforming senior managers who are “managed out” of one trust only to “reincarnate” in another, their fat payoffs and failures seemingly wiped clean. These “rotten apples,” Streeting argues, are giving the rest of the profession a bad name and must be weeded out.
Those rotten apples are unacceptable and give the rest of the profession a bad name, so we’ve got to manage those out.
– Health Secretary Wes Streeting
Under the new regime, chief executives’ pay would be linked to performance, with “no more rewards for failure.” Trusts would also be banned from using agencies to plug entry-level vacancies, stemming the flow of staff leaving permanent NHS jobs for lucrative agency work in a vacancy-filling shell game. In the starkest indicator of accountability, league tables would expose the best and worst performing hospitals for all to see.
A 44-Point Gulf in A&E Performance
Streeting points to the yawning chasm in current hospital performance as Exhibit A for why radical reform is needed. In urgent and emergency care, for example, the percentage of patients seen within 4 hours in Type 1 A&Es ranges from an impressive 83% in one trust to a dismal 38.2% in another – a staggering 44 percentage point gulf. For the Health Secretary, understanding whether this is due to broader system challenges or individual leadership failings is critical.
We need to understand, in those poorest performing areas, is that because of wider contextual challenges, wider system challenges? And if so, let’s provide the national support in to fix those fundamental problems in the system, so we don’t keep on in that doom loop of underperformance.
– Health Secretary Wes Streeting
Medics Push Back: “Demoralizing” and “Simplistic”
But medical leaders are not convinced, warning that far from motivating improvement, league tables could sap morale in a service already on its knees. Dr Adrian Boyle, President of the Royal College of Emergency Medicine, cautioned that rankings could prove “demoralizing” for staff working flat out in the most challenging of circumstances.
There’s nothing more demoralizing than going to work, busting a gut for your patients, and knowing that despite your best efforts you’re letting them down because you’re not given the tools to do the job, and you’re working in a context where … you’ve got poor leadership.
– Health Secretary Wes Streeting
Other senior NHS figures dismissed the tables as a “blunt” and “overly simplistic” tool that failed to capture the nuances behind performance variation and risked triggering a spiral of decline in struggling organizations branded as “failing.”
No “Rewards for Failure” – But at What Cost?
The uncompromising “no rewards for failure” message may play well with a public weary of headlines about hefty payoffs for leaders who have presided over serious care scandals. But some worry that in appearing to crackdown on “rotten apples,” the government is simply looking for scapegoats while shirking its responsibility to properly fund and support the healers on the frontline. As one trust chair put it: “We’re being asked to run hospitals on a wing and prayer.”
Streeting insists this is not a punitive exercise but an “empowering” one aimed at targeting support where it is most needed. By benchmarking performance in a “data-driven” way, he argues, the league tables will identify not just poor performers in need of intervention, but the shining stars from which others can learn best practices.
Where we have poorly performing senior managers, I’ll make no apology for managing those people out … But I also want to recognise that there are some outstanding leaders right across the NHS.
– Health Secretary Wes Streeting
Tough Love or Toxic Blame Game?
Whether Streeting’s tough love approach will be the bitter pill needed to cure an ailing service remains to be seen. With A&E delays, record waiting lists, overstretched budgets and a growing staffing crisis, the NHS is already on life support after the pummeling of the pandemic. The fear among many on the frontline is that in reaching for a facile managerial fix focused on rooting out “bad apples,” Streeting risks triggering a toxic blame game with demoralizing league tables as its centerpiece – rather than uniting people around the more complex, system-wide solutions the moment demands.
In his speech later today, Streeting will paint his plan as an ambitious blueprint to make the NHS “fighting fit for the future.” But as an anxious service awaits the full details, many will be wondering if naming and shaming is really the morale boost beleaguered hospitals need – or a bitter pill this workforce can actually swallow. The fierce debate is likely only just beginning.
