Conclusion: making it happen
This section ismainly a summary and a timetable of the legislation.
"Much work now needs to be undertaken over the next two to three years, both to manage the transition, as well as to flesh out the policy details." (6.2)
Remember that this has been described as the biggest re-organisation of the NHS in its 60 year history, and the white paper indicates that it will be rushed through in just two to three years. There will be no pause for democratic accountability to take effect, your only chance will be in May 2015 when you will finally have a say about what you think of the de-nationalisation of the NHS. By then there will be no publicly owned hospitals and most services will be performed by private companies with the NHS merely a brand name for the source of (some, but not all) of the money that pays for your healthcare.
"To support the ownership of the strategy within the NHS and to inform the implementation of this White Paper, the Department of Health will carry out a series of consultation activities with: patients, their representative groups and the public; NHS staff, their representative and professional bodies; local government; and the voluntary, social enterprise and independent sectors. This will run in parallel to the formal consultation on the proposals above." (6.5)
This is your invitation to indicate that you dislike some or all of this white paper. However, remember that the Department of Health has 31 spin doctors. This is more than any other department and more than the Prime Minister or the Cabinet Office. If you hear of an event local to you, ask all of your friends, neighbours and relatives to attend. Make sure that your opinion is heard and recorded.
"Reforming the foundation trust model, removing restrictions and enabling new governance arrangements, increasing transparency in their functions, repealing foundation trust deauthorisation and enabling the abolition of the NHS trust model;" (6.7)
The Foundation Trust model was intended to give local people control of the governance of hospitals. The idea was that if a hospital delivered bad services or changed services then the public would have a mechanism to hold the hospital management to account. This accountability is being removed. (Note that Mid Staffs Foundation Trust became a Foundation Trust after the period when the services deteriorated. The newly elected governors were informed during their first governors' meeting that the hospital was being investigated by the Healthcare Commission.)
Foundation Trust status was always intended to be an accolade of excellence. The idea that the trusts that could prove that they had excellence in management and governance would be allowed greater freedom to manage their budgets. But before they would get this autonomy they would have to prove that they had the skills.
Initially, trusts had to show that they had achieved high levels of financial probity before they could be authorised as a Foundation Trust, however, following Mid Staffs the regulator, Monitor, introduced more stringent conditions which included higher standards of clinical quality. The Labour government then introduced legislation that allowed Monitor to de-authorise existing Foundation Trusts if they fell below these financial and health quality standards. The fact that the white paper says that all hospitals will have to become Foundation Trusts by 2014 and that they will repeal the laws allowing Monitor to de-authorise Foundation Trusts shows that the government does not treat Foundation Trusts as models of excellence.
The current government are only interested in the fact that Foundation Trusts have autonomy from strategic health authorities. The government indicate that they do not care about the quality of the hospitals' financial or clinical services.
"We are clear about the coherent strategy, and we will engage people in understanding this and its implications. We are consulting on how best to implement these changes. In particular, the Department would welcome comments on the implementation of the proposals requiring primary legislation, and will publish a response to the views raised on the White Paper and the associated papers, prior to the introduction of the Bill. Comments should be sent by 5th October 2010, to: [the Department of Health]"(6.8)
The contact details are:
White Paper team
Department of Health
London SW1A 2NS
Please, also send a copy of your comments to your MP and (since local authorities will get substantial new responsibilities) to your local county, district and town councillors.