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

Thursday, 7 January 2010

Conservative Draft Manifesto 2010: Dissection Part 2

An analysis of the Conservative Draft Manifesto 2010.

"[We will] set NHS providers free to innovate by ensuring they become autonomous Foundation Trusts."

This is already government policy. The Labour government created the legislation for Foundation Trusts in 2003 (and with additional legislation in 2006). The idea was to keep hospital trusts completely within the NHS but to remove political control. The model was based on mutual societies like building societies, Foundation Trusts are known as Public Benefit Corporations.

Foundation trusts are autonomous; they are not subject to control from Strategic Health Authorities, nor the Department of Health. They are funded in the same way as NHS hospital trusts but they are able to take out commercial loans. Unlike NHS hospital trusts (where there is no cap) there is a cap on the income that Foundation Trusts can earn from performing private work. Foundation Trust governance is designed to be more localised and democratic. The governing body of a FT is the council of governors, the majority of governors are elected from the public membership and the rest are stakeholder governors appointed by bodies like local authorities, primary care trusts, medical schools and GP representatives. The council of governors have the power to remove the chief executive of the Trust, and they have the power to appoint non-executive directors.

The idea of Foundation Trusts is that the trust is accountable to the governors, and the public governors are accountable to the membership. Membership has to be representative of the local area, and is typically an opt-in system where members of the public apply to the trust for membership. Public-elected governors have to be members, and typically trusts insist that governors live within the constituency they represent.

Foundation Trusts are not perfect and the model needs more work (for example, the role of governor is often misunderstood, their powers are limited and this results in governors behaving in a timid manner). However, they are a movement in the right direction, that is, making hospital trusts more localised and less subject to central control. Remember, this is not Red Tory localism, this is Labour handing power back to the community. It is nice to see that the Conservatives are following Labour party policies but it would be better if David Cameron acknowledged this.

During the passage of the original 2003 Health and Social Care Bill most Conservatives voted against the policy (see the analysis here and here on the Public Whip website). It would also be honest if David Cameron announced that the Conservative party has reversed its opposition to this Labour policy, and it would be instructive to know why they changed their minds.

"We will unleash an information revolution in the NHS by making detailed data about the performance of trusts, hospitals, GPs, doctors and other staff available to the public online... [we will] enable patients to rate hospitals and doctors according to the quality of their care."

Well this happens already, as I mentioned in my blog post yesterday.

Results of national targets are published online. The raw data is available from the Department of Health website, and there is additional information (including patients' reviews) on the NHS Choices website. The Care Quality Commission website also has reports about the quality of clinical care, and the Dr Foster website has what they call Quality Accounts Summary for every hospital in England.

So performance data is already published on the Department of Health website and patients are able to rate hospitals and GPs on the NHS Choices website. It seems to me that that part of the Conservative Manifesto has already been implemented, so why do they include it?

Yet again, the Conservative policy lists what already happens!

"We will focus on the health results that really matter, like improving cancer and stroke survival rates or reducing infections."

This happens already, there are targets about these issues. If you want to see how well your local hospital handles infections then you can look up how well they perform in the MRSA or C-Diff targets on the websites mentioned above.

No comments:

Post a Comment