|New Foundations for the NHS|
|The case for Foundation Hospitals|
|Setting up the National Health Service in 1948 was the most important achievement of the post war Labour Governments. It freed millions of people from the fear of becoming ill and not being able to afford the cost of treatment. When Bevan became Minister of Health in 1945, the pre-war insurance-based health service was on the point of collapse. Mass unemployment in the 1930s and the Second World War had left many of the schemes virtually bankrupt. Again because it was insurance-based, it was not universal. The unemployed, chronically sick and children were often excluded. Bevan swept away the whole antiquated system and replaced it with a modern comprehensive state-run service. The new NHS was to be comprehensive, universal and free at the point of useThough some charges were introduced later, the principle of a free health service remains intact to this day. .|
management structure of the new NHS was highly centralised.
For many years it worked very well and the health of the nation
improved enormously. The
downside was that the community involvement and social solidarity which
typified the old mutuals like the friendly societies and co-ops faded
away. These were replaced by
a more managerial approach: efficient but remote.
But looking back over fifty years of the NHS, perhaps it’s time
to re-assess how the service should interface with the local community?
how do you make an organisation which employs over a million people
responsive to local needs? How
can you decentralise and still retain a consistent quality of service.
The Tories version of decentralisation was the internal market
and GP fund-holders? It didn’t
work and only made things worse.
It meant armies of accountants but less doctors and nurses.
The fundamental principle was wrong.
It was producer led not consumer led.
Local communities were disregarded.
The government is seeking to remedy this.
That’s why it has decided to introduce NHS Foundation Trusts.
The Foundation Trusts will be a new form of social ownership.
Central-state ownership will be replaced by local ownership by
will it work?
Earned Autonomy means that hospitals will have to prove they are very
efficiently run before they will be ‘given’ the extra freedoms.
Only the top performing 3 star hospitals will be considered.
This needs looking at. If
mutual governance is better, as it should be, then it should benefit
‘under performing’ Trusts just as much as the ‘high fliers’.
Selecting only the top hospitals lays the government open to the
charge of elitism. Perhaps
it would be better to twin the new Foundation Trusts with one of their
‘failing’ neighbours. Both
would then benefit. Some
critics are worried about the Trusts being able to have separate
agreements with their staff. They
fear that this could lead to the Trusts ‘poaching’ staff from other
parts of the NHS. This need
not happen but would have to be kept under review.
in the recent Mutuo pamphlet ‘Making
Healthcare Mutual’**, Health
Minister Hazel Blears MP has indicated that the Government is committed to
extending mutual ownership across the NHS.
She said, ‘Foundation
Hospitals will only be a start. The
new governance arrangements for Primary Care could also be modelled on
successful mutual and co-operative organisations too.
These reforms are every bit as radical and progressive as those
which created the NHS over fifty years ago.
They draw on the traditions of social and community ownership and
place a premium on local accountability’. Making
Foundation Hospitals directly accountable to the communities that they
serve should bring the NHS closer to them by giving them a real sense of
‘ownership’.. We should
give this bold initiative our full support and wish it every success.
Healthcare Mutual’ by
Hazel Blears MP and others
is published by . Price:£10
This Article was first published in the Chartist March 2003