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Models for preventing and addressing failure


In the current climate of intense demand and stretched resources, NHS trusts are under growing pressure to meet strict financial targets while maintaining the high quality of the care they provide.

Health regulators in England have a range of powers they use when trusts, or wider health economies, do not meet these standards. The management and priorities of trusts and wider regions can be, have been, and are shaped by these powers, the most important of which are:

  • special measures
  • financial special measures
  • the failure regime
  • the success regime

This series of briefings has been designed to help members to understand these powers, how, why and when they are utilised, and the ways in which they may impact on doctors.

  • Special measures

    Special measures are an intensive programme of quality improvement, used where a trust is found to have serious failings in the quality of care it provides.

    This briefing explains why and how special measures are applied, what the regime might mean for doctors, and provides a review of the experience of each trusts to have entered special measures.

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  • Financial special measures

    Financial special measures is designed to rapidly stabilise and improve financial performance at trusts that have failed to agree, or to meet, a financial control total.

    Introduced in 2016 as a means of tackling rising provider deficits and the pressures facing NHS providers, financial special measures is a key regulatory intervention for NHSI (NHS Improvement). This briefing covers the terms of financial special measures, the trusts that have entered the regime, what it has meant for those trusts, and what it can mean for doctors.

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  • Failure regime

    The failure regime (or trust special administration) is the process through which ‘unsustainable’ or ‘failed’ trusts are placed into administration.

    Administration has very rarely been used, but still stands a possible last resort for regulators. This briefing sets out the terms under which it can be used, how it has been used previously, and what it could mean for doctors. 

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  • Success regime

    The success regime aims to facilitate systemic reform throughout a local health and care economy. The regime brings together providers from across a region to cooperate in order to improve the sustainability and quality of the care they all deliver.

    This briefing reviews the role of the success regime, provides updates on how it has been applied in practice, and explores how it fits into changing NHS priorities.

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  • Failure in integrated care structures

    The creation of new integrated care structures, including the five vanguard care models, STPs, ICSs and ACOs has raised many questions around regulation and oversight. One primary question is whether and how the chief regulatory bodies NHSI (NHS Improvement) and CQC (Care Quality Commission) will oversee and prevent failure in new bodies created to implement those structures.

    The following briefing examines NHSI and CQC’s adapted approach to the regulation and application of existing interventions to new bodies. 

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