"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Tuesday, 28 December 2010

What about hospitals?

In the next blog I will comment on a recent blog by Paul Corrigan about the political hole that the government is digging itself, but before I do that, I must first wind back and explain the context of the issue.

The white paper says very little about hospitals, but the significant section is 4.21:
"Our ambition is to create the largest and most vibrant social enterprise sector in the world."
The first point to make is that half of US hospitals (2,918) are social enterprises, so how Lansley expects the 436 NHS hospitals in England to be bigger than 2,918 is anyone's guess.

The white paper goes on to say:
"As all NHS trusts become foundation trusts, staff will have an opportunity to transform their organisations into employee-led social enterprises"
This is saying that the plan is for management buy-outs. The rather interesting thing about the government's response to the consultation on the white paper (Next Steps) is that they back track from this position. Not only have they back tracked (which is good), but that they have back tracked without there being much opposition to this policy (well, some people like me - and notably the public service unions - have opposed the policy, but few others have, and few people who the Conservatives actually listen to). It would be interesting to know why they have back tracked. Perhaps we will never know.

Next Steps points out the lack of response in section 6.17:
Regulating healthcare providers discussed the prospect of enabling FTs to have employee-only memberships. Not many respondents commented on this proposal but, with some exceptions, those that did were generally not supportive.
In other words, Lansley has said that he wants management buy-outs and the response has been Meh. Few people (other than us usual suspects) have said that this is the end of the NHS as we know it, but equally so, few people have said "this is wonderful". Lansley (or is it Letwin?) responds to this by saying (effectively): "we have given you an ideal opportunity to get rid of the NHS and you ungrateful bastards are unwilling to congratulate us".

On the one hand I am happy, but on the other hand I am scared. The problem is that the fact that there were so few people running around saying that the demise of the NHS was a good thing means that the demise of the NHS is not being publicised. Those of us trying to rally the public against the worst policy a Conservative government has ever produced, have been denied our best weapon: the enthusiasm of the privatisers.

Section 6.18 points out that the government is disappointed that the public have not warmed to their big idea:
However, we remain convinced that employees should be given new opportunities to provide innovative services, and an alternative way to achieve this is for staff to set up their own independent organisations to run services. Staff providing community health services in PCTs already have the “right to request” to set up an employee-led social enterprise; the Government is exploring a similar “right to provide” for staff working in NHS trusts, and will actively encourage FTs to consider similar requests from their staff.
They say that even though the public don't want it, we will get it anyway. Their new idea is that we will get the "employee-led social enterprises" piecemeal, a department here, a department there, but the hospital will remain in public ownership.

The white paper (section 4.23) says:
Within three years, we will support all NHS trusts to become foundation trusts. It will not be an option for organisations to decide to remain as an NHS trust rather than become or be part of a foundation trust and in due course, we will repeal the NHS trust legislative model.
About half of hospital trusts are Foundation Trusts meaning that about half are NHS Trusts. This section says that all hospitals will have to be FTs because the concept of a NHS Trust will be abolished in three years time.  The question (as I have asked before) is will all trusts be able to convert? The answer is undoubtedly "no", which raises the question of what will happen to those trusts that cannot become Foundation Trusts. That is the subject of my next post.

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