Chippenham - Save Our Beds

Save our beds

By Laura Williams

AN action group of patients, doctors and councillors has been formed to stop hospital beds being closed in Chippenham.

GPs fear newly appointed neighbourhood teams are already unable to cope and the situation will get worse when beds are reduced from 43 to ten.

A public meeting is to be held at Chippenham Town Hall on March 1 or 8 .

Dr Nick Brown, a GP at Chippenham’s Rowden Surgery, said that sections of the neighbourhood teams are not taking new referrals and so beds are being blocked in the hospital.

North Wiltshire MP James Gray said: “I am going to try and persuade the government that these are cuts too far and will result in a worsening of health care in the area.”

A letter highlighting fears has been drafted and Dr Brown wants as many people as possible to send it to Alan Johnson, the Secretary of State for Health.

It reads: “It is clear that local NHS managers, in their rush to meet financial and political targets, are completely disregarding the views of the local people, practice based commissioners and clinicians.”

Dr Robert Muir, a GP at Chippenham’s Lodge Surgery, said: “I’m extremely concerned about the future with the loss of beds. The neighbourhood teams, as hard as they try, will struggle to cope.”

Gladys Ferris’s husband Granville, 82, who suffers from Crohn’s Disease is a patient at Chippenham Hospital. She is worried about the care he will get when discharged.

She said: “We had several different neighbourhood teams come to help us but it was all so confusing.

One day we’d get a couple of nurses and the next none at all. And of course, there was no help through the night.”

A spokesman for Carers Support said: “The impact of all of this on the carers is colossal. The biggest problem is that the neighbourhood teams were promised to provide 24/7 care, but there are big chunks when this does not happen.”

Chippenham Hospital League of Friends representative Elizabeth Sexton said: “We would like to see the beds stay open because they are desperately needed.”

UNISON representative Roger Davey said: “There’s stress on the neighbourhood teams and staff morale is low.”

A spokesman for Wiltshire PCT said: “Patient care is our absolute priority. There is no evidence to suggest that Neighbourhood Teams have refused any appropriate referral. Patients will only be discharged when they are fit to be discharged, and when arrangements are in place for care at home.”

The Department of Health has created the “conditions for a market to grow and thrive”

Did you know that the Commercial Director for the Department of Health is a former senior executive of the US Healthcare business United Health? The report below is from the Financial Times

Patients are urged to embrace choice for better care.

Chan Wheeler the American former senior executive with the US healthcare group United Health, has faced tough questions since taking over as commercial director for the Department of Health. He has been grilled on donations made to the republican party and over millions of dollars worth of backdated share options he received when at UnitedHealth.

He has also inherited stalled plans to buy additional private care for NHS patients and dealt with suggestions that the Prime Minister was hesitating over how vigorously to pursue policies on choice, competition and the private sector to reform the NHS. Although a review of the procurement programme has seen the overall value of the deals shrink from £6bn to £2bn, this has been offset by plans for £1.25bn over five years for new GP surgeries and health centres open to private companies to run. This will be accompanied by full choice between private and public hospitals for routine operations by April.

He says: “What needs to be achieved is conditions where entrepreneurs and investors can look at opportunities in those markets understand how they can . . . pursue them, and get their returns.” And the department has, he insists, “created the conditions for a market to grow and thrive”. As for the backdated share options and the US Securities and Exchange Commission’s investigation into them, he says: “I have never been the subject or target of any investigation.”

In the same issue of the paper we also have the following piece. No “discrimination” will be allowed against those nice private health companies.

Code to promote use of private hospitals.

A new code allowing all hospitals to market themselves to NHS patients, coupled with measures to stop PCTs obfuscating patients rights to use them at the NHS’s expense, has been promised by Chan Wheeler, the health department’s commercial director.

Mr Wheeler also said that the time was right for a “dynamic market” in the private supply of hospital and primary care to the NHS. This is despite the cancellation of much of the second wave of independent sector treatment centres and the slow takeoff in the numbers of patients exercising choice over private hospitals.

From this April, patients will be able to choose from any private hospital that agrees to be paid NHS tariffs. In 2004, health ministers said the numbers talking this route would be up to 15%. However Mr Wheeler said the figure was less than 5%. New competition principles published late last year require PCTs to allow “any willing provider” to treat NHS patients at NHS prices.

“We will push choice in terms of raising awareness” through videos in GPs’ surgeries and libraries, he said. The planned code will allow hospitals to market more freely to NHS patients. I personally expect the independent sector providers in their self-interest to promote the fact that in their local communities they are now available for free choice as of next April,” said Mr Wheeler. Importantly, a change to the software for “choose and book” will list all hospitals in order of distance from the patient. Previously PCTs had been able to choose those that appeared on the first screen, with private hospital groups complaining that most do not put local private hospitals on it. From April, Mr Wheeler said, “that will not be allowed to occur”. There will be “a non-discriminatory view of choice” with patients able to see what is available.

Longer working hours and bigger workloads affecting NHS morale

The NHS Together campaign is publishing research showing that NHS staff are working longer hours, have more work to do and are feeling increasingly demotivated and demoralised. Fewer than half of NHS staff would recommend their job or career to others. A survey of just under 25,000 employees working throughout the NHS found that over half the staff questioned (57 per cent) were working more than their contracted hours and over four-fifths (84 per cent) said that their workload had increased in the last year. Almost two-thirds (65 per cent) of staff working more than their contracted hours were not getting paid for this extra work. Citing the reasons for their extra workload, over three-quarters (77 per cent) blamed additional duties and responsibilities, nearly half (47 per cent) said it was down to insufficient sickness, maternity or holiday cover, and another 45 per cent identified vacancy freezes and redundancies as the cause. 

The survey - undertaken for the unions by Incomes Data Services - found that over half (54 per cent) the NHS staff questioned reported that their increased workload had lead to them experiencing increased levels of stress which was having a negative impact on their relationships with family and friends. Four in ten of the staff (42 per cent) who had more work to do said the extra stress was also damaging their health. 

Nearly two-thirds (61 per cent) of the NHS staff told researchers that their motivation and morale had worsened in the past twelve months, and almost the same number (60 per cent) had considered leaving their job in the last year. The most common reason for staff continuing to work in the NHS (59 per cent) was the belief that they were doing something worthwhile.

 Violence and harassment at work were sadly also commonplace, with four in ten (41 per cent) saying they had been the victims of violence or abuse in the past year. Nearly two-thirds (61 per cent) said they had been bullied or harassed by patients or their families. Ambulance staff were the most likely (79 per cent) to have experienced violence or abuse.

Foundation Trusts - a real threat the the very existence of the NHS

NHS Foundation Trust Consultation: GMB Union Wiltshire and Swindon Branch Response

A Fundamental flaw in the consultation document

Wiltshire and Swindon Branch of the GMB represent staff working within the Swindon and Marlborough NHS Trust and also patients and potential patients of the trust. Wiltshire & Swindon GMB considers that the ‘consultation’ process is fundamentally flawed because it denies local people and staff the opportunity to discuss whether Foundation Status is desirable, sustainable or necessary, nor does it allow a full discussion of the implications of Foundation Status both for the local and national NHS.

Considering the large focus throughout the consultation document on the importance of the views of patient’s, local people and staff, it is ironic that all of these groups have been denied the right to have any say on whether or not they would like their local trust to convert to a Foundation Trust with all that entails.

Therefore although we are not specifically asked for views regarding the fundamental decision about Foundation Trust status, in line with GMB national policy and the feelings of local members to express our opposition to the prospect of the trust requesting Foundation status.

We believe that the consultation document is heavily biased, outlining the positives of a proposed change but no comment on any possible negative outcomes. Although the principle of Foundation Trust is not out for consultation, we should be give the full facts regarding what negatives there are.

The GMB Position regarding the principle of Foundation Trusts

GMB oppose the creation of Foundation Trusts. We consider this form of organisation as posing a real threat to the very existence of the National Health Service.

Many health experts agree that Foundation Trust status will introduce profit and competition into the NHS and mean that financially better off hospitals will be able to poach staff from less well off trusts.

With competition firmly rooted, NHS Trusts will compete with one another and will spell the end of the sharing of good practice that exists today. Instead Trusts will compete with one another and waist money on advertising etc.

The increasing marketisation of the NHS will inevitably threaten the national dimension of the NHS and in the long term threaten the universal principles which underpin Britain’s health service.

We are opposed to Foundation Status in principle because it is central to the government’s strategy of a competitive market in which Trusts compete with each other and with private companies for patients.

The more the Trust operates like a business the more patients and potential patients are subordinated to profit making.

Subjective/Misleading statements in the consultation document

“Main advantage of Foundation status is that it will bring us even closer to the people who work for us and the people we care for.”

In this section there is no mention of trade unions being an active part in this relationship. There is already an existing negotiating structure within the trust where trade unions and the employers communicate. It is not by any means clear how or what Foundation status will bring the trust closer to the needs of the local community, there is a huge variety of numbers engaging with existing trusts as members and the impact that they have in terms of strategic policy making and to services on the ground is not proven.

We also believe that the consultation is further flawed by the failure to include the governance arrangements in the consultation. The relationship between members, governors and the Board of Directors is critical because it will determine who has the power of decision. For instance, if there is a proposal to stop doing work currently done, owing to financial or other reasons., will the members have the power to vote down such a proposal?

“Healthcare is our Business”

The statements contained in this paragraph are subjective opinions promoted as facts. There is no evidence that Foundation status in itself will lead to the trust “focus(ing) on the needs of patients and our local population”. As far as the view of GMB is concerned Foundation status will mean that the priority of the trust will be financial rather than service based.

The consultation document certainly outlines the perceived benefits of this financial independence, however nothing is mentioned of some of the downsides to this. The Healthcare Commission found that being financially independent also carried risks for trusts, particularly with regards to introducing other policies and initiatives for example Payment by results caused Foundation Trusts serious organisational and financial difficulties.

There is continuing concern that by gaining financial freedom from National government the trust also looses the financial security which comes with that structure. The issue of what would happen where a Foundation Trust to become bankrupt has never been resolved and the potential impact on the national NHS is an unknown quantity.

“Foundation status will also give us more business and commercial opportunities to offer services in new and innovative ways.”

However the Guardian Dec 2004 survey of Chief Executives of Foundation Trusts found that the Chief Execs found themselves “tied up in red tape and denied the commercial flexibility they needed to prosper.”

Will there be better healthcare as a consequence of becoming a Foundation Trust?

The answer in the consultation document to this is evasive. However the Healthcare commission report Dec 2005 stated one of its findings “We did not find significant differences so far on readily available indicators of quality of and access to care between NHS foundation trusts as a whole group and other acute NHS Trusts.”

From national surveys of patients and staff, the Healthcare Commission found that “no significant differences were found between NHS Foundation Trusts and NHS Trusts in relation to experiences of patients, the attitude of staff and provision of care.”

Comments on the Consultation issues:

Although the GMB continue to be opposed to any NHS Trust becoming a Foundation trust we feel it is necessary to comment on the consultation as it is likely to be our only opportunity to do so.

Council of Governors

We believe that the proposal for only 3 staff governors on the Council of Governors is inadequate. The average quoted in the Healthcare Commission report in 2005 was of 5 staff governors. The current proposals are the legal minimum of staff reps allowed on the Council of Governors. The GMB believes that there should be maximum representation of staff on the Council of Governors (some trusts have up to 7). There is evidence to suggest that staff governors are invaluable to the Council of Governors in other trusts. Surrounded by evidence that often newly appointed governors find the role challenging, it is difficult to have influence and have poor training and support the Healthcare Commission found that “(staff governors) seemed to have an advantage over other governors due to a better understanding of the organisation and as members of staff working in the trust they have existing channels of communication to build on.”

It would also be preferable for there to be both representations of clinical and non clinical staff as staff governors to ensure it is not certain members of staff from certain backgrounds and experiences that are represented. There is no mention of this in the consultation document.

Staff involvement/impact on staff

So far as the staff are concerned your failure to commit to maintain NHS wages and conditions of service is an obvious worry. Since you will be able to hold onto ‘surpluses’ then inevitably you will be seeking to cut costs in order to maximise surpluses, and this will impact on staff as well as the work you do. The threat to hard won national terms and conditions for our members working at the trust is a big concern. The fact that national terms and conditions existing and future are not safeguarded for staff , the only comment made is that there are ‘no plans to change them yet’, does not reassure employees.

There is very little detail on how staff will be involved in the Foundation Trust in comparison to the other groups which are being engaged (local people and partners). Although the document states that staff governors will be included in the decisions regarding the strategic direction of the trust, the document fails to cover staff in anymore detail.

It is a requirement prior to recommendation from the Minister for the trust to develop an HR strategy to take them into and beyond transition to Foundation trust. This should be done in partnership with the staff/recognised trade unions. To date this has not happened within Swindon and Marlborough Trust. As a vitally important document for such a wide ranging change this document and preparation along with consultation with the unions regarding this issue should have begun some time ago. GMB has serious concerns that without this preparation the transition to Foundation Trust would be hugely problematic.

Board of Directors

There appears to be no representation of non clinical staff in the proposed make up of the Board of Directors. This would be vital to get a fair representation of the employees involved in service provision within the trust, especially as the majority of staff working within the hospital are non clinical staff.

Consultation on the change of the Trusts name

Ironically this appears to be the only thing that we are actually being fully consulted on.

The GMB consider this decision to be insignificant in comparison with the other issues relating to the possible move to Foundation status. The very requirement to change the name of the trust seems to demonstrate unnecessary bureaucracy and cost which would be better spent elsewhere.

General Points

The timescales are a concern, bearing in mind a decision could be made very quickly following the end of this consultation and we do not believe that the staff, patients or local people have had the opportunity to decide about whether Foundation status is the right decision for their local trust, let alone the detail of how a foundation trust should be run.

Finally, the Trust says that it is making the application because it has been instructed to do so by the government. Whilst it is certainly the aspiration of the government for all Trusts to become Foundation Trusts we can find nothing to show that all trusts are ‘instructed’ to make applications. The government has spoken of giving them all ‘the opportunity’ to do so. There are in fact only 73 Trusts so far that have become Foundations.

We can only conclude therefore that the Trust is making the application because it wants to gain the ‘freedoms’ this gives them. It is therefore supporting the government’s dismantling of the NHS rather than merely following instructions.

For all these reasons we are opposed to the application which is neither in the interests of staff nor service users.

Yours sincerely,

Michelle Gordon

Secretary, Wiltshire & Swindon GMB

Money, Money Money

Martin Wicks reports on recent developments in the NHS.

The commercialisation of the Health Service which we have previously highlighted, has been underlined by a couple of developments recently reported in the press. The Financial Times reported that NHS Foundation Trusts are setting up various forms of charity, joint venture or other arrangements with the private sector to bring in extra cash. The deals are designed to get round legislation that bars trusts from earning a higher proportion of their income from private patients than they did in March 2003, when the law creating the self-governing bodies was introduced.

Research from the Public Finance magazine has shown that:

• the North Bristol NHS Trust is looking to set up a charity to run a new infertility unit where most patients would be private.

• Chelsea and Westminster is examining the use of a private charitable company to expand its private maternity services.

• Great Ormond Street Hospital for Children is doing the same to cover income from its international private patients.

• Basildon and Thurrock is planning a “special purpose vehicle” that would take its private patients.

• University College Hospital (UCLH) has launched a joint venture with Hospital Corporation of America on an international cancer centre. This has seen HCA take over the hospital’s private patient wing, leasing space and paying for services, and sharing profits from private patients with the hospital.

• UCLH is looking to expand the same model into neuro-sciences, cardiac services and obstetrics.

The Foundation Trust Network, which represents the 73 foundation trusts, has repeatedly pressed the Department of Health to lift the private patient income cap.

Meanwhile, the Sunday Times reported that Family doctors are being paid for access to their National Health Service patients by a private health company which is charging the patients £145 to screen them for serious illnesses. More than 50,000 patients have been charged for screening at 250 surgeries for stroke, diabetes and heart disease.

Vanessa Bourne, of the Patients Association, asked:

“Are these tests necessary or are they not ? If they are necessary for the patients then why is the GP not offering them on the NHS ? The GP is abrogating responsibility.”

GPs have received two separate payments from the Health Screen Clinic, the private company: an “administration fee” to write to their NHS patients inviting them to undergo the screening tests and a rental fee to hold the screening sessions in their surgeries at the weekend.

The British Medical Association (BMA) has warned that GPs may be breaking the law by using their NHS patient lists to advertise the private screening tests. A letter sent to regional health bodies states:

“The practices are in breach of the Data Protection Act. They hold patient data as part of their NHS contract. It was never intended, and patients are not aware nor indeed have consented to their personal data being utilised for the purpose of advertising private services.”

Dr Ron Singer, a north London GP and spokesman for the campaign group Keep Our NHS Public, said:

“The GPs are using an NHS resource to offer a private service. The NHS data-base, which is owned by the NHS, not by GP practices, is being used in order to have a contract with a private company.”

A senior member of the Commons health select committee has attacked NHS foundation trusts seeking to circumvent caps imposed by Parliament on their private patient income. Public Finance has discovered that at least four foundations are exploring options to establish third-party bodies to run private patient services.

As the bodies will be separate entities, the income will not be consolidated in the trust accounts. Labour MP Howard Stoate said such actions were not what Parliament intended when it imposed the cap in the 2003 Health Act. He called on the foundation regulator Monitor to review the situation.

“It’s deplorable that this is happening, but my worry is that this is what foundation trusts were almost bound to do,” he said. “Their raison d’être is to generate as much income as they possibly can. It’s hardly surprising they have found ways around it as they are almost duty-bound to be as creative as they possibly can with what they see as a market system to raise cash. It’s regrettable - it harks back to the pre-NHS days when each hospital was an independent business providing services to whoever they could sell health care to.”

Unfortunately Howard, that is the logic of the market which your government has introduced. The government has given Trusts the right to set up “special purpose vehicles”. It wants them to be “entrepreneurial”. They are following the logic of the government’s market system. The only way to stop them doing that is put an end to the market system and to Foundation Trusts.

‘Patients not being given a choice’

From the Swindon Advertiser

By Kevin Burchall

A CONSULTATION over Swindon and Marlborough NHS Trust’s plans to move to foundation status has been branded “bogus.”

Swindon Trades Union Council (TUC) claims staff and users of the Great Western Hospital have been denied the chance to say whether or not they support the plans.

The Swindon TUC says the Government’s bid to create Foundation Trusts will destroy the NHS.

By next year the trust says it will have more flexibility as an independent, not-for-profit corporation with a council of governors and board of directors.

The trust will also have the power to borrow money on the open market and anyone living in the area would be eligible to become a member.

But Swindon TUC secretary Martin Wicks said the trust would be looking to make a surplus and could cut its wage bill.

He said: “The so-called consultation which has been launched by the trust is a bogus one. It has specifically excluded any discussion on foundation status itself, wanting to restrict debate to the detail of becoming one and the name.

“Indeed, the feedback form excludes respondents from indicating whether they agree with or oppose it becoming a Foundation Trust.

“The regulator which is in charge of Foundation Trusts has made it clear that they should concentrate on profit-making work, in order to build up surpluses. They’re expected to behave like any other business.”

Mr Wicks added: “Staff will be wary because the trust has refused to commit itself to maintaining NHS wages and conditions of service. What other conclusion can they draw than the trust will be looking to cut their wage bill in order to make a surplus which they can keep?”

Swindon and Marlborough NHS Trust chief executive Lyn Hill-Tout said the 70 trusts to achieve foundation status in the three years since the option was introduced had offered better services for patients.

She said: “As a Foundation Trust we will be directly accountable to our local population - and so will need to ensure that we continue to provide high quality services that meet the needs of our local population.

“The reason we have not consulted on actually becoming a Foundation Trust is that all NHS Trusts in England are required to achieve Foundation Trust status - it is not something we are able to or requested to consult on.

“What we are requested to consult on are our proposals for achieving Foundation Trust status - such as our future strategy and how we will ensure local accountability through membership and governors. We will have to demonstrate within our application how we have listened to the views of staff and people living within our local communities.

“We have absolutely no intention of cutting wages or conditions of service.”

The trust is holding a series of public meetings. The next one is at Steam on September 11 from 7pm to 9pm. Details about the plans can be viewed at the hospital’s open day on Saturday, September 15 between 10am and 3pm. For more information, visit www.swindon-marlborough.nhs.uk.

Foundation Trust status - bad for the health of the NHS

Swindon Trades Union Council Media Release 6^th August 2007 

Swindon Trades Union Council is calling for a genuine consultation over the proposal of the Swindon & Marlborough NHS Trust to move to Foundation Status. The so-called consultation which has been launched by the Trust is a bogus one. It has specifically excluded any discussion on Foundation Status itself, wanting to restrict debate to the detail of becoming one, and the name. Indeed the feedback form excludes respondents from indicating whether they agree with or oppose it becoming a Foundation Trust. 

Swindon TUC Secretary Martin Wicks says: 

“Staff and local service users should surely have the opportunity to debate the implications of Foundation status. Yet the Trust is merely going through the motions of a ‘consultation’. They want to exclude respondents from opposing their proposal. 

Foundation status is part of the government’s introduction of a competitive market in which free standing Trusts compete with each other and private companies for patients. Monitor, th regulator which is in charge of Foundation Trusts has made it clear that they should concentrate on profit-making work, in order to build up surpluses. They are expected to behave “like any other business”. 

Already around £1 billion has been squeezed out of the NHS by these organisations. 

The government is handing over public property to them allowing them to keep the proceeds from the selling off of assets. 

The government is destroying the NHS as a national service. They are putting profit-making above the interests of the health of the population. That is why Swindon TUC, together with the health service unions are opposed to Foundation Status. It can only to lead to inequalities in health care from one part of the country to another. 

Staff will be wary because the Trust has refused to commit itself to maintaining NHS wages and conditions of service. What other conclusion can they draw than the Trust will be looking to cut their wage bill in order to make a ‘surplus’ which they can keep.” 

Swindon TUC has produced a briefing on Foundation Status which can be read or downloaded from its web site at:  http://swindontuc.wordpress.com/2007/08/01/foundation-status-behaving-like-any-other-business/ 

For further comment contact Martin Wicks on 07786 394593 

Foundation Status - “behaving like any other business”

Swindon Trades Union Council: Foundation Status Briefing 

Foundation Trust Download the document in PDF

Swindon & Marlborough Trust is holding a ‘consultation’ (from July 9^th to September 29^th) on the proposal to become a Foundation Trust. A genuine consultation would involve a discussion on the merits or drawbacks of Foundation Trust Status. However, the Trust makes it plain in their consultation document that such a discussion is not on their agenda.  

“The consultation is not a vote on whether we should become an NHS Foundation Trust. It is to seek views on our plans to become one.”

In other words the Trust has decided to become a FT and they are not prepared to have a discussion on whether or not it is a good idea to do so. The Reply Form that they have produced does not include a question on whether or not you support the move to Foundation Status. 

This renders the ‘consultation’ a bogus one. Surely staff and local people should have the opportunity to discuss the implications and potential consequences of FT status otherwise we are restricted to discussing the detail of becoming a Foundation Trust. There is no democracy in this. 

Swindon TUC is therefore calling for a genuine discussion in which staff and residents have the opportunity to say whether they are in favour of, or opposed to, the move to a FT. 

What are Foundation Trusts? 

FT’s are said to be “independent, not-for-profit public benefit corporations”. In fact, when they can keep their surpluses, they are likely to organise their ‘business’ in such a way as to maximise them. The consultation document is full of business language. It says that FTS provides “business and commercial opportunities” for them. 

FT’s are part of the government’s policy to introduce a competitive market in which self-standing Trusts compete with each other and private companies for patients. In fact the ‘market’ in ‘elective’ surgery has been rigged in favour of the private companies. They have been guaranteed payment for the work they are contracted to do, even if they don’t carry out the contracted amount. In contrast NHS Trusts have been paid insufficient money if they do “too much” work. 

The government has declared that it wants all Trusts to be Foundation ones. It envisaged them all becoming such by 2008. But only 70 have done so thus far. 

Both the government and the Trust try to placate staff and users by saying that health provision will continue to be free at the point of delivery. However, by abandoning collaboration between different components of the NHS and making them compete with each other for patients, the government is progressively destroying the NHS as a national service. Work has been taken away from Trusts and handed over to private companies. The decision that all Trusts must break even treats them like profit-making businesses and has led to financial crises. Trusts were condemned by Patricia Hewitt for “doing too much work”. What were they supposed to do, turn sick people away? The amount of work that any Trust is liable to have is unpredictable given the fact that individuals do not fall sick by rota. 

Introducing market anarchy makes planning impossible and can only lead to ‘winners’ and ‘losers’. And the ‘winners’ will see their ‘business’ as driving up their level of surpluses. 

Amongst the ‘strategic objectives’ of the Trust you can read: “Increase the number of patients choosing our services from Wiltshire, Oxfordshire, Berkshire and Gloucestershire.” In other words, they want to take patients and money away from other trusts. 

“Profit Centres” 

It is clear that the ethos of the NHS has been abandoned and Trusts are being turned into money making businesses. This is more so the case with Foundation Trusts. In March of this year the Times reported that Monitor (the organisation which regulates FT’s) had told them “to identify the services and treatments on which they turn a profit. In the last resort, that could lead to some ceasing to provide services that do not make money. The moves mark a further injection of market disciplines into the NHS…”  

By the end of next year Monitor will expect all NHS hospitals applying for FT status “to scrutinise their balance sheet in this way”. 

“Monitor was providing tools to help foundation trusts work out which “service lines” they made money from under the NHS price list or tariff.”  

Where they were making money, they could consider expanding the work to boost surpluses that could be reinvested in services, said William Moyes, Chair of Monitor.  

Currently, primary care trusts could require a foundation trust to provide anything that it designated as a ‘core service’.  

“But the time may come when foundation trusts may be able to walk away from a service, provided we are confident that the primary care trust has alternative suppliers.”  

The aim was to “understand profitability, efficiency and quality - and to strike the right balance between the three”, he said, with hospitals merely “behaving like any other business” and understanding their profit and loss centres.  

All foundation trust applicants would be expected in time to have such data - and “once they have the information, they would be pretty stupid not to use it”, Mr Moyes added. 

So the body which regulates FT’s is telling them to concentrate on “profitable” work, whilst it predicts that they may not always have to carry out ‘core services’. 

Money in the bank

In the statement of preliminary results for March 2006 Monitor said that FT’s need to deliver larger surpluses. “…it is essential that we move swiftly to an environment where securing significant surpluses is the norm, rather than the exception”. Already FT’s have built up significant surpluses. In 2006-07 they made a surplus of £130 million, increasing their “profit margin to 6.7%”. 

FT’s have been given the right by the government to sell off land (previously a public asset) and keep the receipts. Previously the money from this would go into the NHS pot and be re-distributed to areas of greatest need.  

If you add up this year’s profits, together with that of previous years plus the money from sale of assets the FT’s have unspent reserves of £995 million. This is money which has in effect been taken out of the NHS and is lost to it. 

The “Benefits” 

The Swindon & Marlborough Trust says that “the main advantage” of gaining FT status is that “it will bring us even closer to the people who work for us and the people we care for.” 

Staff and members of the public will be able to become ‘members’ of the Trust (more on this below). 

In a section headed “Healthcare is our business” the Trust says that FT status will “require a change in the culture of the organisation to become even more focussed on the needs of patients and our local population.” It will give the Trust “greater financial freedom to develop facilities and services and to reflect local needs and wishes more closely.” 

And, most importantly (from the viewpoint of the management) “it will also give us more business and commercial opportunities (our emphasis) to offer services in new and innovative ways.” 

This is so much spin. Take for instance the assertion that it will bring the management ‘closer’ to the staff. The reality of the implications of FT status is reflected in the refusal of the Trust management to commit themselves maintain NHS wages and conditions of service. What other conclusion can staff draw than management are likely to want cut their wage bill in order to ensure they make a ‘surplus’ which they can keep. 

So far as the needs of patients are concerned, when the profit motive is entrenched in the system then patient needs will take second place. 

More “Freedom”

The experience of FT’s elsewhere shows how the process of turning them into businesses tends to lead to management’s wanting to operate away from public scrutiny, on the supposed grounds of ‘commercially sensitive’ decisions. 

The Manchester Evening News recently reported that “Health bosses at Wythenshawe Hospital have voted to stop holding monthly board meetings in public in order to protect commercial information.” 

“NHS hospitals are required to hold open meetings unless discussing sensitive information. But Wythenshawe has more freedom because it is a foundation trust. Both Steeping Hill Hospital and Hope Hospital made similar decisions when they achieved foundation status…”  

Yasmin Zalzala, a regular attendee of Wythenshawe’s board meetings, said:  “I am furious about the decision. I think it is wrong that they should be deciding how to use public money in private. We keep hearing how patients should have more information and more choice in the NHS, but this seems to be going the opposite way.”  

Jeff Wilner, chairman of the University Hospital of South Manchester, defending the decision, said: “We do not get many people at our meetings and we often make commercially sensitive decisions. We have almost 9,000 members and they elect a council or representatives, and they will be invited to our board meetings four times a year. They will be given an appropriate minute (???) of our meetings. We have found we are repeating items in the public and private sessions and it is not an efficient use of our time.”  

Martin Rathfelder, of Manchester Health Watchdog, said: “Board meetings across Manchester have become less open as trusts are increasingly run as businesses. It makes me wonder what they are talking about in private that they do not want people to know about. I am not very happy - public organisations should make their decisions public.” Will Swindon & Marlborough Trust make a public commitment that all its Board Meetings will be held in public? 

In June the Times reported that: “There are advantages to being special, and foundation trusts are making the most of their station. Nursing Times reports that these trusts are using their independent status to opt out of reporting clinical incidents, saying the guidance on reporting incidents to the National Patient Safety Agency (NPSA) does not apply to them.”  It is not mandatory for any trust to use the reporting system, but a large majority of NHS trusts are signed up to it. But Monitor, the foundation trust regulator, says it is up to individual foundations trusts to decide.” 

Members and Governors

Much is made by the Trust about the ‘membership’ system which is allowed in FT’s. Staff will automatically be members unless they ‘opt out’, whilst residents in the catchment area can apply to be members. They will be able to: 

·         Vote for governors “to represent their views” on the FT’s new Council of Governors.

·         Stand for election as a governor.

·         Be consulted about our plans for future healthcare services and hospital facilities.

·         Contribute views and ideas to the improvement of patient care.

·         Receive regular communication from the Trust about its activities. 

There are some key questions about these arrangements, above all the question of accountability. Once members elect a governor, how can they ensure that they “represent their views” on the Council of Governors? Will there be any hustings for candidates? Will they be able to write explaining why they are standing and what their views on the health service are? And what procedure would there be available to members if they felt that the governor elected in their constituency was not representing their views? 

The Trust says that members will be consulted about plans for future healthcare services and hospital facilities. But ‘consultation’ most often means that management tell you what they are going to do, ignore what problems you raise and go ahead and do it anyway. 

What about the Governors? The Trust says that their role is to: 

“provide the link between the local community and the Trust Board. Their role will involve securing engagement with the local community to ensure a strong link between the views, needs and aspirations of our communities and the decisions made by the Trust Board about our services and how they should be delivered.” 

Engagement; what does it mean? What we suspect it means is that governors would ‘take on board’ peoples views but in fact act as individuals pursuing their own agenda. Will there be any obligation on Governors to meet with the people who elected them? 

The Trust refers to “constitutional arrangements that clearly define the role of members, governors and the Board of Directors.” Will these constitutional arrangements be part of the consultation? If not then it would merely serve to underline that it is not a genuine consultation. The relationship between these three components will determine who has power of decision. Despite all the spin about members being able to ‘influence’ decisions we expect that power will reside in the hands of the Board of Directors. The Board of Governors will be responsible only for “strategic” direction. The day to day management will rest with the Board of Governors. Will governors be able to challenge or block management proposals? 

The test of whether or not members had real ‘influence’ would be, for instance, if they were balloted over a proposal to end provision of a particular service by the Trust – a big decision which will affect local people, meaning that they might have to travel elsewhere. Will the ‘members’ have any power other than electing governors? And will they be representatives of members, accountable to them? 

Summary 

Swindon TUC is opposed to FT status because it represents part of the process of the break up of the NHS, and its transformation into a business, in which self-standing Trusts war with each other for ‘customers’. It is clear from the decisions of Monitor that FT’s are expected to concentrate on ‘profitable’ work and to abandon ‘un-profitable’ activity. We have come a long way since our then MP Julia Drown assured us that private companies would not be involved in clinical activity within the NHS. 

If the ‘consultation’ is to be a genuine one then local people should have the opportunity to express a view on whether or not the Trust should move to becoming a FT. 

Trust staff should be put on their guard by the refusal of management to make a commitment to maintain NHS national pay and conditions of service. 

Far from concentrating on the “needs of patients and local people” a FT will concentrate of pushing up surpluses and trying to dispense with ‘unprofitable’ work, for some other organisation to bear the cost. 

The competitive market will inevitably create ‘winners’ and ‘losers’. It will lead to the growth of inequalities in health provision from one area to another. 

Some questions to the Trust 

From the foregoing with have the following questions for the Swindon & Marlborough Trust. 

1. Why will they not make a commitment to maintain NHS wages and conditions of service?
2. Will they make a commitment that all Board meetings will be held in public if they become an FT? Will members have a right to attend them?
3. Will the “constitutional arrangements” be published as part of the consultation?
4. What procedure is the Trust proposing for election of Governors?
5. Will governors be accountable to members? Will they have an obligation to hold periodic meetings open to members in the constituency they represent?
6. What will be the relationship between the governors and the Board of Directors? Will the governors have the power to override proposals of the Board?

Foundation Status - bad for the health of the NHS

Swindon & Marlborough NHS Trust is holding what they describe as a consultation (from July 9^th until September 29^th) on the proposal to become a Foundation Trust. Sadly this is not a genuine consultation, one in which the pros and cons of a proposal are seriously discussed. The Trust has stated that it is not a consultation over whether or not Foundation status is a good idea. Swindon TUC is therefore appealing for a genuine discussion on what Foundation status involves, what its consequences are.

We are opposed to the government’s policy which seeks to introduce a competitive health market, in which free standing Hospital Trusts compete with each other for patients. The Trust is trying to sell their proposal as a means of gaining ‘local control’. In fact it will give local management a certain freedom from NHS control. But, the main consequences of such a move will be the commercialisation of the service. Their first ‘strategic goal’ will be to gain patients from other Trusts.

Foundation Trusts are said to be “independent, not-for-profit public benefit corporations”. In fact when they can keep their surpluses, they are going to organise their ‘business’ in such a way as to maximise their surpluses. One of the advantages of Foundation status for the management is that they can withdraw from nationally negotiated wages and conditions of service for staff. The Trust has refused to give any commitment that it will not do so. If they do, rest assured that it will not be to improve the wages or to cut the workload for staff.

Whilst the government has said it will maintain treatment free at the point of use, its ‘market’ is undermining the foundations of the NHS as a national service in which different parts of the system co-operated with each other. In its place are competing Trusts fighting each other for the available work.

We have seen the introduction of private companies into what is in many respects a rigged market. Companies have been guaranteed money even when they have not fulfilled their contracts. These companies have thus been paid for operations they have not done, whilst financial pressures have been raised on NHS Trusts. This is just a first brief comment on the ‘consultation’ over Foundation status. We will be making a submission opposing Foundation status and will be producing a briefing which explains in detail the government’s policy, driven by their ideological commitment to ‘market’ methods.

Warning: ambulances are bad for your health

From the Swindon Advertiser, first published Monday 18th Jun 2007.

A PARAMEDIC has said the town’s dirty ambulances could be the cause of superbug infections such as MRSA.

Figures released by medical watchdog the Healthcare Commission showed that three out of the four NHS trusts running the town’s health services were failing to meet Government targets for cleanliness and patient care.

The Great Western Ambulance service failed to meet nine different standards including providing a safe and secure environment for patients, minimising their risk of contamination from medical devices and managing patients’ records effectively.

One Swindon paramedic said he was not surprised Swindon’s ambulance service had fared so badly.

“We don’t have time to clean vehicles. We transport people into hospitals and that is the weak link,” he said.

“We are giving them MRSA. For most patients the ambulance is their first port of call.

“As soon as we have cleared the hospital we are on to another job. We can only wipe down a bit of blood, but don’t have time to give anything a thorough clean.

“We really want downtime to make sure we can keep ambulances sterile and give patients proper care, but it just isn’t possible with the emphasis on targets.”

The Healthcare Commission said the ambulance trust failed to challenge discrimination, set up systems to value and develop staff and give workers adequate mandatory training.

The paramedic, concerned for the welfare of patients, said: “The training college in Chippenham has been closed down. The building is just standing empty, and we are not getting any training at all.

“They have recently had interviews for new emergency care assistants to drive ambulances. But when the applicants asked about where the training would be, they said they didn’t know.”

Director of corporate development Rachel Pearce said: “Staff at all levels have worked very hard to meet the standards set.

“In particular, we are pleased that we have achieved compliance with key areas of the hygiene code of infection control, decontamination and healthcare environment.

“This year we want to exceed our own standards on that front - and we will be introducing special cleaning and restocking teams for ambulances. This will enable front line staff to get on with the core job of providing urgent and emergency care.

“We were disappointed not to achieve 100 per cent compliance last year. However, we have a performance improvement plan in place to address this. It is monitored monthly by our board and we expect to address all standards of non-compliance in the next 12 months.”

Ms Pearce said the trust also wanted to improve staff development and aimed to target recruitment towards black and ethnic minority groups.

Swindon Primary Care Trust and Avon and Wiltshire Mental Health Partnership NHS Trust also failed to meet several core standards for hygiene, infection control and controlling MRSA.

Only the Swindon and Marlborough NHS Trust, which runs the Great Western Hospital, managed to meet all of its core standards.

Across the country, the figures released by the Healthcare Commission yesterday showed that more NHS trusts had failed to meet targets for hygiene than last year.

Neighbouring Wiltshire PCT was one of the worst scoring trusts in the country for hygiene.