Foundation Hospitals - classic or dud?

"This is about more than electoral politics. It's about whether we are to achieve Labour's goals of a fairer country where everyone shares in increased opportunity and prosperity... Part of the bargain with the public who are providing the money is that we make sure it delivers the improved services they want to see. And that means reform is every bit as important as extra money..." - T Blair

vs

"Foundation Hospitals are based on a 'pick and mix' approach to health service delivery which allows them to choose which services they provide and expand their private patient care to make a profit. They will be destructive to the Labour ethos of a free, fair and accessible health service for everyone and goes against the integration efforts of Agenda for Change. The introduction of this divisive philosophy will devastate the core values of the NHS and create a multi-tier health service where quality of care and availability of services is based on your post code and not on your need." - John Edmonds, General Secretary of the GMB

Maybe watch a) what's happened with schools in the UK over the last 30 years? (TES headline last week re 'Middle classes have benefited most from reforms' [ie despite every conceivable effort to produce different outcome] b) what's happened with Canadian health system, ie anybody who just can't wait (in these matters it's pretty impossible to separate 'need' from 'impatience'/'queue-jumping' etc) just goes to USA to pay over-the-odds, med-establishment brain-drain follows, unresolveable irresistable-force/immoveable-object scenario whereby anybody w/ resources will do ANYTHING to get around perceived 'rationing' and only solution in sight seems to be either a) let some ppl suffer when they don't 'have' to b) let EVERYONE suffer the same. Sorry that wasn't really an answer was it, just restating what you said. I'm interested in this topic though as I hear alot about this as some relatives of mine back home are in medical 'industry' and I hear alot about the unbelievable levels of frustration in this profession (which of course probably aren't comparable to the levels of frustration [ie life-or-death scenario] in system's 'customers' or whatever they're called now)

Edmonds OTM.

*Part of the bargain with the public who are providing the money is that we make sure it delivers the improved services they want to see* (Blair)

So how does it work when you provide the money, fall ill and then find out that no hospitals in your area can adequately treat you because you have an 'unprofitable' disease?

Bringing in *profitability* as a performance measure will inevitably lead to worse service for the majority of people who can't afford private healthcare. How will profits be spent? Obv the default is - pumped back into the most profitable areas again, like in business - a doomsday scenario is that there could be whole areas of medicine where treatments actually get worse. No investment in research, no specialism, no advances, nowhere that knows how to treat certain 'unprofitable' diseases.

And how is profitability achieved? Take more and more private patients, squeezing out NHS patients? Or 'save' more of the budget you've been allocated by the Govt by cutting 'non-essential' services?

After initial high hopes, Blair's two terms have been a disgrace. Low inflation, low interest rates and lower unemployment are fine, and in general the economy has been well-managed, but for what? The two big issues - radical reforms of the health service and education - have been put off continually. Whatever is done will be unpopular, mean higher taxation and REAL change, but what better time to start than now when we have an economic tail-wind?

Yes, the worrying thing is that, with the post-Baghdad bump, when he could probably get away with whatever he felt like, Blair seems to feel valorised, not to take on "the forces of Conservatism" (like Ken did with the Congestion Charge), but rather to be even more forceful in taking on the back-benchers/unions/Guardianistas.

The Guardian on this issue :

Looks like they are 'non-profit making' and there is a non-NHS quota. It looks like the only thing that separates a foundation hospital from a standard NHS one is the freedom to get over their heads in debt *all by themselves*! Thus absolving the govmt of any need to bail them out. Cool! Also, just what is the advantage of individual hospitals being able to borrow money, when the govmt could do it for ALL hospitals at lower interest rates + the ability to raise taxes, spread risk etc? It's like arguing that the sweetshop on the corner can buy 50 bags of bertie bassetts on more favourable terms than Tesco, who buy 50,000 at a time.

John Carvel, social affairs editor
Friday March 14, 2003
The Guardian

The government acted to head off a growing backbench rebellion against its NHS legislation last night by severely curbing the independence and powers of foundation hospitals.
Although they will escape direct ministerial control, there will be strict limits on the number of private patients they can treat, the pay rates they can offer, and the extent to which they can depart from the values and traditions of the NHS.

Alan Milburn, the health secretary, was so keen to show that his proposals would not lead to a two-tier NHS that he may have taken away many of the reasons why 32 of England's best hospital trusts have been attracted to apply for a place in the first wave of conversion to foundation status in April 2004. The health and social care bill published yesterday says foundation hospital trusts will be set up as "public benefit corporations", governed by boards that will for the most part be elected by local people and staff.

Earlier drafts of the bill referred to the trusts as "companies", but that word does not occur in the 135 pages of text.

Mr Milburn said this was "a new model of public ownership, firmly rooted in the cooperative and mutual tradition". Foundation trusts would be owned and controlled by local communities, rather than central government or shareholders. "They will be not-for-profit organisations, wholly part of the NHS, subject to NHS standards and inspections, but no longer directed from Whitehall."

Their affairs would be supervised by a regulator who will be obliged to intervene if they do anything detrimental to the wider NHS.

Specifically, the bill imposes a statutory duty on foundation trusts not to increase above the current level the proportion of income derived from private patients. John Hutton, the health minister, said he was ex amining how applicants for foundation status might be encouraged to give up private work altogether. The restriction on private work was inserted to allay the fears of the 124 Labour backbenchers who have signed a motion criticising the proposals. Seven had added their names in the preceding 24 hours.

Many feared that foundation hospitals would be under financial pressure to take more private patients to pay back the extra money they would be allowed to borrow. They are also concerned that foundation hospitals might be able to poach the best staff by offering higher pay.

Mr Hutton said the regulator would stop unfair poaching and limit local pay flexibility to the amount agreed with the unions in the recently negotiated agenda for change. A foundation trust would be able to retain income from selling surplus assets and borrow without government permission as long as it did not exceed prudent limits.

The loans would not be underwritten by the government. In the event of insolvency, the regulator would have the power to sack the board and pass the assets to another NHS body or the secretary of state.

Mr Hutton said the banks could be assured that the regulator would not let foundation trusts over-extend themselves. In the event of a default, income would continue to flow from treating NHS patients.

Every NHS trust would be able to gain foundation status "over the next four to five years," he said. But he denied that this implied a devaluation of the government's earlier commitment to maintain tight control of weak hospitals. Within five years, all NHS hospitals would have improved. Under the plan to make foundation trusts accountable to their communities, people in the catchment area would pay £1 to become members of the corporation, entitled to vote by post to elect more than half the board of governors.

Gill Morgan, chief executive of the NHS Confederation, representing health service managers and trusts, said: "We believe foundations could be an important first step towards a more decentralised NHS."

But Frank Dobson, a former Labour health secretary and leading critic of the plans, said most backbenchers would not be impressed by the concessions. "The regulator will not be able to break the law on employment or human rights.

"Foundation hospitals will be better funded. Nobody can stop staff from neighbouring hospitals applying for jobs there. Ministers say all hospitals will be foundation in four or five years. That's a long time to be at the back of a queue. As time goes by, poaching will increase in intensity, because there will be more poachers and fewer people to poach."

Main points

· The bill enables a new type of foundation hospital in England, providing free care to NHS patients but without Whitehall's direct control.

· Foundation hospitals will be not-for-profit "public interest corporations". Governors will be elected by local people, but decisions will be closely supervised by an independent regulator.

· They will not be allowed to reduce their commitment to the NHS by taking on more private patients.

· The bill will set up tougher inspectorates for all hospitals and social services.

· The bill enables the NHS to recover from insurers the cost of treating people who receive injury compensation.

· The welfare food scheme will be reformed to give pregnant women, mothers and young children better access to a healthy diet.

· Primary care trusts will be responsible for NHS dentistry.

Dr C has spoken, so we can but agree. He is a doctor. (And I agree anyway.)

Anyone who ever voted for Blair is an asshole. Fact.

The hospital near where I am working has got a Burger King. There must be a neat expression to describe this, like 'taking coals to Newcastle', but I can't think of it just now.

'offering Simon Weston a comedy exploding cigar'?