Study of NHS trusts shows finance and care failings

WIDE discrepancies in the number of patients treated, as much as 50 per cent difference between hospitals of similar size, have emerged in one of the most comprehensive studies into the National Health Service reforms.

The research by the Audit Commission, published today, shows that much of the failure is a direct result of the way the fledgling trust hospitals and community services are organised and managed.

Despite such areas of concern discovered during the 18-month research into the management of the new trusts, which now account for 90 per cent of all NHS services, the commission says that the jury is still out on whether the reforms are a success. A report earlier this week, though, found that increasing numbers of trusts were failing to hit their financial targets.

However, the commission has undertaken to produce a further report by the end of the year which will seek to settle the argument that the reforms have led to a mushrooming of bureaucracy and a large increase in the number of managers. A pilot study points to a reclassification of roles within hospitals rather than massive growth, but the sample of four sites was too small to be conclusive.

The commission's auditors will spend at least a month in each trust hospital or unit using the report, Trusting in the Future: Towards an Audit Agenda for NHS Providers, as a framework to test whether they match up to its benchmark before reporting to each management.

Much of the 37-page document is taken up with outlining the standards and management systems which the auditors expect to see to unlock the freedoms and benefits that trusts should have acquired from abandoning the old centrally- controlled system.

Andrew Foster, the commission's controller and former deputy chief executive of the NHS, while far from uncritical of trusts, said managers were attempting to make the changes within complex organisations. However, a significant number had failed to take advantage of the changes, and in some instances almost all had failed in critical areas of staff management.

High sickness levels among staff in some trusts as a result of poor resource management was extremely costly. The commission estimates that if all had the same nurse sickness levels as the best - 25 per cent - the equivalent of pounds 180m would have been saved in the 1991-92 financial year.

Low job satisfaction and high staff turnover are other areas which the commission highlights as a result of poor management, particularly inadequate recruiting and training policies and a failure to communicate the reasons for the changes in the new goals.

Virginia Bottomley, Secretary of State for Health, welcomed the contents of the report. But David Blunkett, Labour's health spokesman, laid the blame for any shortcomings at the Government's door, reiterating its call for the setting up of an efficiency unit to tackle the variations in productivity between hospitals.

Liz Lynne, for the Liberal Democrats, said it would be impossible for trusts to meet the targets set by the commission without effective financial support from the Department of Health.

Trusting in the Future: Towards an Audit Agenda for NHS Providers; HMSO; pounds 8.50.