and staff. The first "failing" NHS hospitals This effectively revives and are likely to be handed over to amplifies the original promises of "self-governing status" made external management as we go by Thatcher's government to press, with the lingering fear that private firms might be when it first set up the internal market twelve years ago, and brouent in to take charge, as New Labour's offensive gath- pressed hospitals to "opt out" ers pace. of health authority control.
Health Secretary Alan Of course the right for Trusts Milburn continues his mission to vary local pay and conditions to seek and destroy any last proved - as trade unions and vestiges of morale amongst campaigners had warned - to be little more than a license for The latest phase of Milburn's Trust bosses to award themrelentless campaign for "mod- selves huge increases in their ernisation", which has involved own pay, and squeeze down a non-stop round of bafflingly the terms and conditions of the complex and apparently point- majority of their staff. less organisational reforms on new Labour, under pressure the one hand, coupled with from health unions, restored setting ever-more rigorous national pay agreements -performance targets on the though many Trusts have yet to other, includes the reintroduc- iron out all of the anomalies and injustices that arose from tion of two of the most hated elements of the Tory internal local pay bargaining. But now market system, which Labour an ambitious attempt to claimed to have scrapped in revamp and simplify NHS pay scales has run into the ground 1997.
The top-performing hospital for lack of cash, Milburn has Trusts are to be given new effectively reversed the process powers to run as "foundation towards a rational system ... hospitals", facing a bare mini- and headed towards an even mum of intervention or control more chaotic and arbitrary from the Department of arrangement. Health, given extra cash, and But Thatcher's chief reason with freedom to set up compa- for imposing the costly marketnies, and to set their own pay style reforms on the NHS was and conditions for managers to introduce competition for "market share" between Trusts, whose income would depend on how many contracts it could secure from health authorities and GR fundholders.
Now Milburn is bringing back precisely this element of competition which New Labour proudly claimed in 1997 to have replaced by a new notion of "partnership" . This time the competition between Trusts is dressed up as offering patients a "choice" of which hospital to use, though in many areas there is only one NHS hospital to choose from.
Gulf
But while the "freedoms" to act more like a private business are being doled out to the topflight hospitals, there is a widening gulf between them and those deemed to be "failing". The dozen hospitals branded as "no-star" Trusts six months ago have been under the cosh, with a threat that if they fail to raise standards their management will be replaced -by "successful" Trust bosses.
Several of the no-star Trusts have struggled, and now four -Barnet and Chase Farm (where the Chief Executive has just resigned after a stash of 2,700 unfulfilled requests for ultra-