eflection on the 2003 reforms and “foundation” trusts

Jo Revell in The Observer 28th September 2003 reportsed: £2.5m cost of hospital reform ‘spin’

So what value have we the patients had from this reorganisation? How has anything changed? This was an example of bureaucracy at its worst, and is a lesson on what not to do. The perverse incentive to become a “foundation” trust, put patients second to managerial ambition.

Move increases opposition of MPs to two-tier health system

More than £2.5 million of NHS money is being spent on glossy documents and public consultations by the country’s top-performing hospitals in their bid to become foundation trusts.

Ministers have set aside special funds from a central government budget to help hospitals with the cost of having to consult hundreds of thousands of staff, patients and members of the public about their plans to become more independent.

The revelation that the process will cost so much will fuel opposition to the Government’s controversial proposals that the best-performing hospitals should be given more freedom from Whitehall and allowed to borrow and keep their surpluses.

A resolution at this week’s Labour Party conference in Bournemouth is expected to reject the idea of foundation trusts, as many delegates fear it will lead to a two-tier health system. But the Government intends to push ahead with the plan, seeing it as one of the key planks of its health reforms. The 25 trusts applying for foundation status next April have to consult their patients and staff, as well as local residents.

For large hospitals, this involves compiling enormous electoral databases and sending out consultation papers to more than a million people. They have to invite people to become members of the trust, and to vote or to stand as representatives on members’ councils, taking the place of the NHS boards.

The Observer has learnt that each trust can apply for up to £100,000 from a central budget to help with the costs of the consultation.

A Department of Health spokesman said: ‘When you are creating a membership organisation, it does cost money and there are inherent start-up costs in the preliminary phase of the application process. There is a recognition that you have to help from the centre, [given] the scale of the change.’

But the financial aid has angered those most opposed to the foundation plans, such as former Health Secretary Frank Dobson.

‘I would have thought that most people would like to see this money spent on operations instead of a lot of PR and spin,’ he said last night. ‘But the £100,000 they are getting is probably chickenfeed compared with the real cost of having to put together an electoral list. They have to include everyone who’s ever been a patient as well as all the local residents.’

He is hoping the Health and Social Care Bill, the legislation under which foundation trusts would be set up, will be defeated in the Lords in two weeks’ time. However, it seems likely that the peers will back an amendment calling for the scheme to be piloted properly for at least two years before it is finally introduced.

Hospitals are already sending out consultation documents on their plans to become foundations. The document from University College London Hospitals argues that foundation status ‘can provide even better services, drive up standards of care and create a state-of-the-art environment of which we can all be proud’.

According to the brochure, the new status will allow them to ‘gain a reputation for developing staff and a “can-do”culture’, and to apply the new employment conditions and pay for staff earlier than the rest of the NHS.

Last week the leader of Britain’s 120,000 doctors said the proposal threatened the fundamental principles on which the health service was founded.

‘We should aim to level up the standard of care, not introduce changes that could enable our top hospitals to widen the gap,’ said Dr Jim Johnson, BMA chairman.

This entry was posted in A Personal View, Commissioning, Perverse Incentives, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s