Reform, not improvement - article for Campaign Group News, October 2003.
I recently received the formal “consultation” document from University Hospital Trust in Birmingham about their bid to achieve foundation status. In it they say this change will enable them to involve and serve local people better because decisions will be made locally rather than in Whitehall. Yet they are not putting the principle of becoming a foundation trust to local people (click here for info on adding your view). That is a fait accompli that calls into question the Trust’s commitment to real accountability, as do the remarks at a conference of the Chair of the Trust, reported in the Health Services Journal. “I am in favour of foundation trusts” he said “essentially to get certain people off our backs. Yes, let's have autonomy, let’s have accountability, but for goodness sake don't expect us to have a 5,000 strong membership. That would be an absolute nightmare.....We have a huge private finance scheme and I want him (referring to the Chief Executive) concentrating on that. I don't want him spending all his time out recruiting members of the local co-op.”
Notwithstanding these comments, the consultation conforms to Government requirements and includes an application for membership with the promise of exciting benefits such as attendance at seminars and access to a members-only website. It is true that members will be able to elect half of the Foundation Trust’s Board of Governors (others will be appointed by "stakeholders") who will have some say in the selection process for non-executive directors and, through them, the appointment of executive directors. However, the current directors have devised a system that will enable them to retain their influence for many years to come. And if the Trust does achieve the “nightmare” of 5000 members or even a few more, they will be no more representative of the 400,000 people for whom the Trust is the district general hospital, let alone the 4 million who look to the Trust for specialist services, than are existing consultative arrangements involving four patients’ councils.
If we want those responsible for running pubic services to be genuinely accountable to the people they serve, this can only be done through elections in which everyone has a vote and the people they elect have real power. The governance arrangements for foundation trusts do not begin to meet these requirements. Furthermore it is also misleading to suggest that foundation trusts will be free of control from Whitehall. Foundation trusts will be subject to a Whitehall-appointed regulator and, like other hospitals, they will be inspected by the Government-appointed Commission for Healthcare Audit and Inspection. All hospital trusts, foundation or otherwise, are subject to legally-binding agreements with primary care trusts (PCTs) that are themselves subject to a range of Government targets, which affect what services they commission. Ultimately, if a foundation trust fails to meet Government standards, the Government will be able to remove its foundation status.
Foundation hospitals will do nothing to improve accountability in the NHS. Their development, together with the decision to commission diagnostic and treatment centres from the private sector rather than building up NHS capacity, plays into the hands of the Tories who must be having a good laugh at the associated decision to abandon our pledge to abolish the internal market and instead to re-create their system whereby “money follows the patient”. Should we ever be unfortunate to have to suffer another Tory Government, we will have handed them a blue-print to privatise and fragment the NHS. If we really believe in decentralisation we should be planning to hand over health services to regional government. Meanwhile, the most obvious unit of accountability would be through PCTs which commission and pay for services for a specific catchment area. These bodies also provide primary care and community services and were conceived as being pivotal in developing a primary care-led NHS. Foundation trusts undermine this concept, again demonstrating the Government’s inconsistent and illogical approach which seems mainly designed to win approval from the likes of the Daily Mail. When will the Leadership of our Party realise that reform is not the same as improvement?