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

Friday, 29 March 2013

Creating More Mid Staffs

Robert Francis QC ascribes the poor care at Mid Staffs to:
The Trust prioritised its finances and its FT application over its quality of care, and failed to put patients at the centre of its work.

This is very clear: tight finances, so the trust was cutting staff (particularly nurses) and an obsession with achieving FT status above everything else, were the main drivers. The management of Mid Staffs was clearly poor and should have been replaced. In a recent debate in the Commons, Andy Burnham says:
In a national health service, there are areas where national direction is needed, and when things go wrong, there must be immediate powers of intervention, which, on my arrival in the Department in June 2009, I found I did not have. Foundation trust policy needs to be reviewed and adjusted to mitigate those dangers, including through a reconsideration of the power to de-authorise a failing foundation trust, which was recommended by the first Francis report, but repealed by the Health and Social Care Act 2012.
The original Act that created Foundation Trusts made them autonomous of Parliament which meant that they were no longer accountable to Parliament through the Secretary of State and so there was no power for Ministers to replace the management. On arriving at the Department of Health Andy Burnham found that he could not replace the management of Mid Staffs, the only people who could do that was Monitor. Indeed, it was Monitor who authorised a trust to be a Foundation Trust, it was not a case of the Minister deciding. It was Andy Burnham who changed the law to allow a Foundation Trust to be de-authorised, taken back under ministerial control so that the government can change the management.

The original Foundation Trust programme under New Labour was flawed. These three things were at fault: tight finances, Foundation Trust authorisation deadline and lack of ministerial control over Foundation Trusts.

At the 2010 election the Conservatives fully supported the Foundation Trust programme saying:
[We will] set NHS providers free to innovate by ensuring they become autonomous Foundation Trusts.
The Health and Social Care Act has several sections on "autonomy" which includes repealing the law that allowed Foundation Trusts to be de-authorised. Further, the White Paper on the NHS reorganisation said that all NHS Trusts must become Foundation Trusts within three years. The deadline was first put at April 2014, but then it was relaxed to April 2016. This deadline is as tight as the FT programme under New Labour.

Sixty percent of an NHS trust's income comes from Payments by Results (a fixed payment for activity)  and the current government has cut the PbR National Tariff by 1.5% in 2011/12, 1.5% in 2012/13 and from April this year, by another 1.3%. That means that NHS Trust incomes are going down. If an NHS Trust is efficient and makes a surplus on PbR payments, it cannot keep the surplus (this is a privilege that only FTs have) and instead the surplus is clawed back by the government as part of its deficit reduction programme. This means that NHS Trusts are under increasing financial pressure.

The three things that resulted in poor care at Mid Staffs are worse under the Coalition government, and they have been deliberately made worse. Indeed, the government could have retained the ministerial ability to de-authorise a failing Foundation Trust, but the government have deliberately repealed this law.

There is currently a Conservative HQ orchestrated attack on Andy Burnham. It is clear that it is orchestrated because the attacks are all the same, using the same language and the same points. Conservative HQ have used minor Tory MPs (so far Chris Skidmore, Charlotte Leslie and Steve Barclay) to make these attacks initially. They are testing the water to see how much mud sticks, and if it does, they will launch a much bigger attack using higher profile MPs. The sheer hypocrisy of these attacks is breath-taking. Rather than attacking Burnham (who tried to address the issues of Mid Staffs) the Tories should be learning from his actions to ensure that the situation will not happen again. Instead, the Tories are putting together the pieces to create many more Mid Staffs and are doing it fully warned of the consequences.

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