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

Friday, 22 July 2011

When it comes to hypocrisy, Lib Dems are the Masters

Unless, of course, you are a Minister. The government was adamant during the white paper: all NHS Trusts have to become a Foundation Trust by April 2014, to do this each Trust had to match the tight financial criteria that Monitor sets and any Trust that failed to become a Foundation Trust would close. The Health and Social Care Bill reinforces this market-based way of reconfiguring services. The drop-down-dead date was brought up in the Pause and the government has relinquished saying (in their response to the Future Forum):

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).


  1. The problem being of course that the second an MP suggests that closing part of a hospital might actually deliver better patient care, the part about them closing part of the hospital will be on every single opposition leaflet, press release or letter to the newspaper, whereas very few will bother reprinting the bits about how it could deliver better care overall. Us voters like the simple messages that can get across in a few words.

  2. @Paul Leake

    Indeed. But aren't we in an age of "new politics"?

    We had a major review in 2007 that would have closed some departments and Cameron promised a "bare knuckled fight" to prevent that from happening. Now he's in the position of having to do the same and although he's hoping that his market approach will close them, it seems that the closures will be at the time of the next election, and the public will blame him (as incumbent). Perhaps he should not have opposed the acute services review...

  3. May I suggest that you also look at the Exorbitant salaries that are paid to NHS executives. Many pay their board members well in excess of £110,000. This is more than the pay of a Brigade Commander serving in Afghanistan who has up to 3,000 men under command and is also "Up to his eyes in muck and bullets." I would suggest that if realistic salaries were paid to Directors that there would be many £100,000's of pounds available Nationally to enhance patient care. Have we, as a Nation, got our priorities right?

  4. @Anonymous

    OK here are some facts taken the latest annual report for Imperial College FT.

    Income: £920m
    Chief Exec (Stephen Smith) £190k - £195k

    I am not an expert in running a billion pound organisation that employs almost 10,000 staff, but I bet you'll not find a single private sector company where the chief exec is paid as little as £200k.

    You mention a Brigadier, where the average salary is about £40k and who command 3k soldiers (fewer staff, of course, than Imperial College FT) and who handle a much lower budget. I would suggest that the issue is that a Brigadier is not paid enough (a good place to start would be the average pay of a private sector chief exec for a company that employs 3k staff), not that the chief executive is paid too much.

    "Have we, as a Nation, got our priorities right?"

    Prioritise health over a foreign war that we should not have been involved in? Yes, I think we have the priority right.