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“Being good today is no guarantee of being good tomorrow” – Dr Jonathan Cave

Jonathan CaveDr Jonathan Cave, an economist from the Department of Economics at the University of Warwick, has researched healthcare systems. He reacts to news that Cambridge University Hospitals Trust has been placed in special measures.

Dr Cave said:

“The placement of institutions such as Addenbrooke's and the Rosie into special measures should raise alarm bells.

“These are in some sense similar to the instability in rankings of schools – being good today is no guarantee of being good tomorrow, especially when resources change in a different direction compared to demand and requirements in ways that are difficult to forecast.

“This situation is magnified by the increasing ‘efficiency’ of institutions forced to operate with wafer-thin margins. A further factor is the interaction of responsibility devolved to the local level with ‘summative’ ranking from outside. Placing an institution in special measures serves at least three functions: it provides extra resources and a different governance arrangement to deal with the problems that have been found; it serves as a disincentive to bad management; and it helps guide patients and others who may have the luxury of choice. It seems evident that these purposes are not all equally well-served. Perhaps an alternative ‘no-fault’ version of special measures, backed up by concrete and understandable evidence that they work, would help.

“A second issue concerns the spill-over impacts of special measures; the assessment of the Cambridgeshire institutions rated the personal aspects of quality care as excellent; the problems came in availability and timing. There is at least a potential risk, already seen in other institutions, that the demoralising impact may destroy what is excellent in order to bring what is unsatisfactory up to a minimally acceptable level.

“Finally, it seems almost inevitable that growing budget constraints combined with growing demand will bring more institutions into special measures or inequitably degrade special measures’ standards and resources. A system designed to address rare and scattered failings may not ‘scale’ well.”

Notes to Editors:

Contact Lee Page, Communications Manager at The University of Warwick. Tel: +44 (0)2476 574 255. Mob: +44 (0)7920 531 221. Email:


Lee Page, Communications Manager

Tel: +44 (0)2476 574 255.

Mob: +44 (0)7920 531 221.