To
Mark Britnell
Chief Executive
NHS Foundation Trust Office
University Hospital Birmingham NHS Trust
Freepost NAT7693
PO Box 9551
Birmingham
B15 2DR

My response:

I am writing in response to the above consultation.

The “consultation” process is fundamentally flawed as you do not put the central question of accepting or rejecting the principle of foundation trust status into the document.  You say the change to a foundation trust will enable you to involve and serve local people better because decisions will be made locally rather than in Whitehall.  Yet, your stated reason for not putting the principle of becoming a foundation trust to local people is because it is Government Policy, even though the necessary legislation has not been approved by parliament.  Surely this calls into question the Trust’s commitment to real accountability.

Even though you propose that patients and residents who become members of the Trust will be able to elect half of the Foundation Trust’s Board of Governors, the current directors have devised a system that will enable them to retain their influence for many years to come.  The current Chair is on record as regarding a membership of 5000 as being a “nightmare” and time will, of course, have to be spent servicing the membership rather than concentrating on patient care.  Furthermore, you do not explain how a membership of this size will be any more representative of the 400,000 people living in South Birmingham for whom Selly Oak and the QE are their local hospitals (let alone the 4 million who look to your Trust for specialist services) than are the people you have recruited to your four Patients’ Councils.

Though I am in favour of those running public services being genuinely accountable to the people they serve, this can only be done through elections in which everyone has a vote and the people they elect have real power.  The governance arrangements for foundation trusts do not begin to meet these requirements.  Thousands will be spent on elections when the elected members’ powers are unclear and weak.  Furthermore it is also misleading to suggest that foundation trusts will be free of control from Whitehall.  Foundation trusts will be subject to a Whitehall-appointed regulator and, like other hospitals, they will be inspected by the Government-appointed Commission for Healthcare Audit and Inspection.  All hospital trusts, foundation or otherwise, are subject to legally-binding agreements with primary care trusts (PCTs) that are themselves subject to a range of Government targets, which affect what services they commission.  Ultimately, if a foundation trust fails to meet Government standards, the Government will be able to remove its foundation status.

Foundation hospitals will do nothing to improve accountability in the NHS.  Their creation will merely serve to confuse people as to where true responsibility lies.

The whole thrust of the consultation document is that foundation trust status will lead to improvements in patient care and contribute to the regeneration of Birmingham.

But nowhere is it explained how the “freedoms” of foundation status will achieve this, other than that you will be able to access money more quickly - not mentioning that since there will be no extra money overall, this has to be to the detriment of other parts of the health service.

I support you entirely in the aspirations set out in the document in relation to improved patient care and clinical standards, commitment and support of staff and congratulate you on the considerable progress that has already been made.  But what has this got to do with being a foundation hospital?  You say you believe you can achieve your aims better and quicker as an NHS foundation trust but offer no reasons for this belief.  For this consultation to have any meaning you should surely explain what obstacles to better performance foundation status will help you overcome.

You also say that foundation trust status is not about “poaching” staff, so why did you use the term “first mover advantage” in the report recommending the Trust to express an interest in becoming a foundation hospital?   Surely the effect of granting what is, in effect, favoured status in a situation of prolonged staff shortage seems likely to boost recruitment at your institution at the expense of the rest of the NHS.

I oppose the introduction of foundation hospitals because it represents an unnecessary reorganisation and return us to the bureaucracy of the Tories’ internal market. The whole idea is also inconsistent with the last NHS reorganisation that created Primary Care Trusts to be the main drivers of health care development.  It is with these bodies that democratisation of the NHS should begin.

The future of the NHS should be about developing whole systems, not isolated institutions; about building networks across professional and institutional boundaries, not creating new barriers; about sharing IT and information, not reducing connectivity, and about getting more people treated in the community and in primary care, not sucking them into hospitals.  The development of foundation hospitals will do exactly the opposite. They will return us to the fragmentation of the pre-NHS era and render public services ripe for privatisation if we were ever unfortunate enough to get another Tory Government.

LYNNE JONES MP

November 2003