NO, AFTER 40- PM
WAITING TO SEE IF
IT GETS FOUNDATION
HOSPITAL STATUS
MOTOR Why do we need them? We don't. The 3-star Trusts that are being urged to seek Foundation status have achieved their standards within the existing NHS framework, showing that it is not an obstacle to success.
Foundations may be promised the right to borrow from the private sector, but it is unlikely they will be able to afford largescale loans. One accountant has calculated that to service a loan equivalent to a quarter of a Trust's turnover could require the Trust to double its income. NUTE:
Plug ot What difference will they make to patients and the public? Foundation Trusts make it less likely that gaps in service provision can be filled, since their establishment is part of the run-down of any national or regional planning framework within the NHS and its replacement by market-style systems.
Foundation Trusts are likely to concentrate their resources on those services which deliver the largest and most secure return. They may therefore seek to pull out local support for the establishment of a Foundation trust: indeed the first wave applicants for Foundation status have submitted their applications without any prior reference to local people or staff - and made it clear that they will press their application through regardless of local opinion.
All day to day decisions on policy will continue to be taken by the same Board of Directors that currently runs the Trust
A handful of local people may see a value in signing up as "members" and seeking a place on a new 'Board of Governors', or "members' council": but these bodies are marginal to any decision-making, and will have no real control over the hospital or its services. Will Foundation Trusts lead to more competition between hospitals? YES. Foundation Trusts are intended to "unleash local entrepreneurialism" - in other words to compete and take risks to expand as businesses. Since their main customer will be the cash-limited NHS, this puts Foundations in conflict and competition with non-Foundation Trusts.
The new system for funding hospital treatment is being changed to one of payment By Pesults", to give Foundations the 'incentive to compete for more referrals from their existing catchment area and beyond.
Since the new system replicates Margaret Thatcher's internal market in which "the cash follows the patient", the success of Foundation Trusts in increasing revenue and generating surpluses must inevitably be at the expense of "losers" elsewhere.
Non-Foundation Trusts will struggle for ••. viability as they battle to sustain some expensive services which the Foundations opt not to offer. Will Foundation Trusts treat more private patients? YES! The promise to "cap" the expansion of private medical treatment in Foundation Trusts has taken the form of a clause in the Bill which prevents Foundations from increasing the proportion of their income that they derive from private patients.
This means that if Foundations succeed in increasing their overall income, by attracting additional HS contracts from PCTs, they will also be able to expand their private work. Several of the Trusts seeking Foundation status are already among those most dependent on private patient income.
Foundations are also free to sign up to agreements with private medical compa nies, including for-profit companies, which will result in an expansion of private medical treatment - some or all of which may be carried out by consultants and staff employed by the Foundation Trust. FOUNDATiON HOSPITAL
BANX
I'VE BEEN HERE FOUR HOURS ANC NOTHING'S IMPROVED YET J WAITING ROOM.
And of course the Regulator can agree to changes proposed in any Foundation Trust's license. Will this bring a new two-tier system? YES. Of course there are already different levels of resources, performance and quality of care in different NHS hospitals. But instead of focusing resources on improving those currently the furthest below standard, the gap between "failing" hospitals and the 3-star elite will widen as more free. doms and resources are funnelled towards those that are already succeeding at the expense of the rest. Why are the trade unions so opposed to Foundation Trusts? Unions opposed the market-style reforms when first proposed by the Thatcher government in 1989-91, and are still opposed to them today.
Most of the trade union criticisms have centred on the impact of the changes on the NHS as a whole and on patients rather than on staff. Trade union concerns include
• The 2-tier NHS
• The return of a market system which New Labour committed itself to abolish
• The scope for greater links between Foundations and for-profit private companies
• The freedom for Foundations to tear up nationally-negotiated pay structures and impose local-level pay scales - which may also be used to "poach" key sections of staff from neighbouring hospitals