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

Tuesday, 28 December 2010

Will hospitals be local election issues at the next general election?

Paul Corrigan was Tony Blair's special advisor on the NHS and was the architect of the Foundation Trust programme and the Blairite reforms that brought in more private sector involvement into the NHS. He knows a thing or two about the NHS and politics.

It is safe to say that Corrigan is not a fan of Lansley's plans, but he's also not in favour of maintaining the status quo. However, it is interesting to read his opinions and analysis of Lansley's NHS re-organisation.

Corrigan's blog on the government's response to the consultation over the NHS white paper is significant because he's identified the political traps that the new Health Bill will produce. Readers of this blog will know that I am pretty luke warm about GP commissioning, it was going to happen under Labour anyway, and if it is done right (ie not Lansley's way) it could actually improve care. The part of the white paper that no one talks about, and the part that really gets me going, is what Lansley intends to do with hospitals. This is why Corrigan's blog is significant, he explains how Lansley's plan will fail and the significant effect this will have on the Conservatives.

In my last blog I pointed out that all hospital trusts will have to become Foundation Trusts. The government will abolish the NHS Trust model so there will be no option: a hospital trust will have to be a Foundation Trust or not exist at all. Corrigan points out that there are about twenty NHS Trusts that will not be able to become Foundation Trusts: they are too weak in their financial governance, or quality of care, or they simply have debts that are too large.
In early 2011the Government will publish how the pipeline of organisations to become FTs will look. It will provide a map of all hospitals that are not FTs and expectations of when they will make it to FT status. It will outline a menu of local and national support for this pipeline. This will not just involve turnaround teams, but will also have plans for regional health economy reconfigurations, as well as options and mergers.
The last part is significant, as Corrigan points out:

The final date for applications to become a stand-alone FT will be 31/03/2013. ... The legislation will remove the status of non NHS FT trusts from the statute book for any trust beyond April 2014. Within these plans the Provider Development Agency will have one year to work with those organisations that have not applied to become an FT to ensure that they have plans for merger or acquisition before the non FT trust status is abolished.

If the coalition survives, the election will be between spring 2014 and 2015. This means that according to these plans about 20 hospitals will be closing or merging or being taken over in the year before the earliest date of the election. I will be interested to see how those in the Government who are interested in electoral politics take to this timetable. Does David Cameron know this?
Hospitals are the most obvious embodiment of the NHS, people get passionate about their local hospital. The re-organisation of the NHS will mean that the ownership of part (or all) of each NHS hospital will be doubtful. But more significantly, there will be twenty places around the country where NHS hospitals will become election issues. We will see the list of these hospitals next year, but the interesting point is that it will not be the Labour strongholds of the North East because that is an all FT region nor North West because that is 80% there. Most likely these failing NHS trusts will be in one of the Strategic Health Authorities of London, South Central or South East Coast. In other words London and the Home Counties.
The graphic above shows the Strategic Health Authorities and the percentage of the trusts that are Foundation Trusts (shades of grey). England is almost completely blue politically (Conservative) so the graphic just shows the Labour (red) and Liberal Democrat (yellow) areas. What is immediately clear is that other than London it is the predominately Conservative areas that have a low number of Foundation Trusts.


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  2. This post gave a very interesting perspective on the issue - but where I live in Hampshire (in one of the safest conservative seat in the country and actually in your black area), there are two nearby very very good hospitals (Frimley Park Hospital and the Royal Surrey). Frimley park itself is one of the best hospitals in the country, as a result I think its unfair to imply (at worst) the conservatives are trying to get more foundation trusts in their constituencies
    Furthermore a family relative (I don't want to name them) has just started at the Royal Surrey and spent the last 7/8 years (or so) at Frimley Park, both in the admin department. One thing they have learnt over the time they've worked at the two Foundation Trusts is that the numbers can all be easily doctored
    Becoming a foundation trust is all about being able to fiddle with the numbers, NOT being a good hospital. Thus even if the current system was to remain as it was (which is more sensible admittedly) the government really should be looking to change the criteria that allows hospitals to become a Foundation Trust

  3. George, I am not trying to suggest that "the conservatives are trying to get more foundation trusts in their constituencies", quite the opposite. About half of hospital trusts are FTs and these are the ones that were "low hanging fruit" - they had good finances. The point I was making is that it is estimated that there are 20 trusts that have poor finances and probably will not be able to make FT status. These trusts cannot exist after NHS Trust status is abolished, and so may close. Hospital closures are big local issues and the point of the post was to try and see whether it will be in Conservative or Labour areas.

    You may well be right about the FT criteria (I have a lot of issues over FT governance) but yours and my issues are not the same as the government's (Lab or Cons). They want hospitals to be autonomous and free standing, which means that FTs have to make the books balance (and number fiddling will soon be discovered when the umbilical to the government is cut). Clinical quality, of course, was secondary, and still is: the government's attitude is that you have the choice to choose a better quality hospital.