We strongly expect that the majority of remaining NHS trusts will be authorised as foundation trusts by April 2014. ... It will not be an option to stay as an NHS trust, but there will no longer be a blanket deadline in the Bill for abolishing NHS trusts as legal entities. All NHS trusts will be required to become foundation trusts as soon as clinically feasible, with an agreed deadline for every trust. (7.17)Note that an NHS Trust cannot remain as such (ie be treated as part of the public system of healthcare provision), under this government the only option is for a Trust to become an autonomous Foundation Trust over which the government will admit no responsibility.
Further, the government says:
To enable time for foundation trusts’ governors to build capability in holding their boards to account, we will further extend, to 2016, the transitional period where Monitor retains specific oversight powers over foundation trusts. Monitor’s oversight will last until two years after a foundation trust is authorised, if that is later. To provide continuity during a challenging period, and in recognition of concerns about the readiness of foundation trusts’ governors, these powers will initially apply to all foundation trusts, and they will be reviewed in 2016. (7.18)This says that after 2016 (or two years after a trust becomes a Foundation Trust, whichever is the later) Foundation Trusts will be completely autonomous of the government or any government agency (including Monitor). This is the "level field" that Lansley keeps talking about because Monitor (as the economic regulator, rather than the Foundation Trust regulator) will treat FTs exactly the same as private and voluntary sector hospitals.
The point of quoting these paragraphs is to show you that the government is intent on allowing hospitals to close - and to use the market to close them. There are many reasons why a hospital loses money, and poor management is just one (and most likely not the most important reason). The hospital could be in an area of high deprivation or some other demographic with a high healthcare cost. The hospital could be in a rural area and consequently serve a population that is not large enough to be economic, but nevertheless be vital for that community.
It makes no sense at all simply to look at the balance sheet and close those hospitals in the red and allow those in the black to continue, the other criteria - the health inequalities in the community being one of the most important - should be taken into account. However, this requires a strategic and planned approach and this government does not do that.
Consequently, the government's market-led approach creates hypocrites of ministers. For example (from the Evening Standard),
In a startling admission, the Work and Pensions Secretary [Iain Duncan Smith] said waiting lists are already growing as he led a campaign against shutting the A&E and maternity units at King George Hospital, Ilford. The ex-Tory leader warned that thousands of patients in his constituency will suffer if the closures go ahead.The last sentence actually explains his worry. It is not thousands of patients he is worried about, it is thousands of voters. However, Duncan Smith, if true to his ideology would do what politicians are supposed to do, and show leadership and explain to the voters why the hospital should suffer the closures that are the bedrock of his government's policy. He doesn't. He's a hypocrite.
However, hypocrisy is not the sole domain of the Conservative party: the Liberal Democrats are hypocrites too. HSJ reports that health minister, Paul Burstow says "services could be put “at risk” by a hospital merger proposed near his constituency on the Surrey-London borders". Burstow says
Any merger that could result in the loss of services, which local residents rely on, will not be tolerated. It is essential that we show local NHS bosses this.Well, Mr Burstow, these market-based reconfigurations are your government's policy. If you are against them, then stop them all. It is pure and utter hypocrisy to say that they should happen everywhere else in the country but should not happen in his backyard where they will affect him electorally (majority 1,608 over Cons).