Monday, December 13, 2004

Foundation Hospitals

I was prompted to write this post by a superb report in today's Guardian, there's some here and here with some extra bits in today's dead tree edition

Firstly, I need to say that I am proud to be a card carrying member of the Labour Party and of UNISON, both of whom are opposed to the Foundation Hospitals policy and I'm also running for election as a Staff Governor of the Yeovil District Hospitals Foundation Trust, which should come into being on 1st April 2005. My position on foundation hospitals is positive, but reserved and I'll touch on that later in this post.

Now, to the point of the post, I doubt that the name of Anglian Harbours NHS Trust will mean anything to anyone who didn't work in NHS Finance or lived in the Lowestoft area in the mid 90s. That trust is, and probably will remain, unique the only NHS Trust to ever go effectively bust.

I'm not saying that YDH is ever likely to go bust, nor any of the other local trusts that I have knowledge of, but the main thrust of the front page article in today's Guardian was that the first wave Foundation Trust Chief Executives are chafing at the red tape that the Department of Health and their Strategic Health Authorities are placing on them. This drives at the heart of the problem.

1. Foundation Trusts are meant to give hospitals commercial freedom and the responsiveness to react to local need, but,
2. No Foundation Trust will be allowed to fail, for fear of the political backlash.

Because no Foundation Trust will be allowed to fail, although for obvious reasons no government minister or DoH official will come out and say that, the government will feel that they need to keep tabs on local Chief Execs, make sure that they spend the Treasury's money wisely, because without that tight control, the centre's scared that a Foundation Trust will go mad and go bust.

Today, if today is an average working day, close to 1,000 businesses will start up in the UK, some of them will become successful, but most will end up closing down. The fact that some of those businesses will fail does not mean that the capitalist system is flawed, neither would the failure of a foundation trust mean that the whole policy is flawed, but the government's opponents would not take such a pragmatic view. It is because of that worry that the first Foundation Trusts are shackled in red tape.

I have heard from a few people, dotted around the NHS over my eight years in the service, that "money will be found" and they laugh at attempts to impose financial responsibilty on their areas. This kind of comment comes more from clinicians and former clinicians that have become managers. What's so frustrating and worrying about their comments are that they are right. If you are a department head, a matron or a clinical director and you want a new post created then you have two ways of doing that, you can do it the proper way, get Management Accounts to cost it up, provide a business case of how that's going to improve patient care, go to meetings and finally get it approved, or you can just appoint someone, circumventing whatever financial controls exist. Actually there's a third way, con another manager into appointing the person on their budget so they get the flak instead.

If you pick the second route, then you need a hard head, you will get told off, but you'll be okay if you adopt the the high moral ground argument, after all, your distractors will be talking about merely money, you are only interested in patient care. Eventually you'll get the funding in some future budget round and everything will be okay. But the money has to be found from somewhere and currently, that's from taking money from the pot available for developments, from those managers trying to play by the rules. But under Foundation Hospitals, the rules change, or would if Foundation Trusts were allowed to run free.

I don't want there to be any bail-outs of Foundation Trusts that are doing badly in either patient care or financial stability. I want failing Trusts to be wound up and all the managers (including the senior clinicians, hell even including the likes of me) in that Trust to be sacked. I say that because I want there to be a wake-up call to the kind of managers I've described, the kind of managers that are far too numerous in today's NHS. If there's no bail outs, then those managers that are responsible will get to see the fruits of their labour and the irresponsible ones will have to shape out or ship out.

Foundation Hospitals has the potential to transform the whole NHS for the better, but only if the centre has the confidence to let the trusts grow-up .