H calth Secretary idea of turning top-flight "3hospital Trusts into "foundation bospitals", which will Parliament this autumn, has been roundly Frank Dobson and by former health spokesman Caris smith.
Now the scheme seems doomed to founder under the onslaught of Gordon Brown's darins, who see in every bid for greater independence a hidden bid to beg or borrow rocketed more money.
Indeed one of the biggest lures to attract big fish like UCLH Trust chief executive Robert Naylor, and other top of foundation bospital status was the initial promise that Trusts the new "freedoms" they would acquire would include place, te rat to scil of surplus new and borrow HASHIC their Funnily enough we have heard these promises before - when Margaret Thatcher's government first came up New burcaucratic "market reforms" in 1989.
code" tives were urged to "opt out"
"self-govern. So ing" Trusts - and promised return they would be Milburn *free" to sell unused land borrow money, fix local pay, and compete against other Trusts for increased contract But even the free market fundaalined that int realised that this HOW CYC level of financial freedom Coleone coach and horses through their system or cash limits for health spending So even before they had been launched, austs were reined in and subjected to strict External Financing Limic And Trusts attempted to impose local pay deals - generally offering staff conditions worse man toe prevaing national rates set under the doms Whitley Council system -most managers found them- other hospitals. selves preoccupied with the endless rounds of contract negotiations with health authorities that were vital to its new, competitive market sys. help poach The system cost billions such more, but delivered little if any improvement in patient Cumbers of senior managed, Waiting lists STATUS administrative staff gushed rhetoric about business methods but became from the In 1997 New Labour came to office committed to just perks one apparently radical policy on health - to sweep away the internal market system. other direction!
but with a "duty to coop. pay bargaining scrapped and ambi.
La new ¡HS pay structure announced its determination eliminate "post rationing and variations in when Alan revives essentially the same Plans COR Thatcher's team first raised 13 years , he is not so With the much reinventing the wheel as reinventing the flat tyre. tions not There are some differences, nobody Hospitals, unlike the original idea of Trusts, posed to offer an clite status, The and would be an option only hospitals for 35 top pertorming hospiSo in place of the generalised competition embodi leaving jed in the Tory internal marwhich resica on the (deluded) idea of a level better care to patients in field". the their immediate vicinity, at Foundation Hospitals would be given extra cash and free- dards and resources in other and thus gain a hospitals... taking us back porchair davantage against to the postcode lottery New Labour promised to end. London, for exam. But there ple, UCIH could in that they theory spend some of allowed to supplement their cash budgets by treating private CATH enhanced pay rates to patients from specialist staff abroad. Foundation hospitals can Barts and The be seen, together with London, the Royal Free and the Whittington. - which are (under which private compa not eligible for foundation nies build, UPHy lease hospitals like the new However one problem they £420m UCLH to the NHS), would have in doing so is and the Concordat under which the NHS buys treathospitals would be excluded ment from private hospitals)
NHS scheme - one of the few gen- from NHS provision of care for NHS- to increasingly private proemployed staff, so the incentives may even work in the But this brings yet another problem, ducked by the Tories. If a foundation hospital is run as it go bust? The Tory reforms at first insisted that ruste which failed in the internal market would be allowed to ministers pump in transitional payWE open to ministers if stanlards of care or performance levels fall off in a foundation hospital? The failure of Thatcher's gruntlement at the state of legislation the NHS were major factors in Tony Blair's landslide vicpublished, tory in 1997, quite knows Perhans this is another rea ine actails will be - though son why the clection-conthe first applications need to scious Chancellor, allocated hope of foundation increases in health spending, would attempts to implement poliavailable work (and revenue) cies that only a handful of from the NHS in their area -hospitals for, and drag us 'back to the their future'?