[A-List] UK corporate state: unhealthy accumulation

["Michael Keaney" <michael.keaney@xxxxxx>]

Elite institutions show the way

John Carvel
Thursday October 10, 2002
The Guardian

If all goes according to plan, the first 10-15 foundation hospitals will
open for business in England in April 2004.

At first they may look familiar to patients. The hospitals will be drawn
from the 52 elite institutions that won three stars in the government's
latest grading exercise. So at the outset the buildings and staff will be
the same.

But Ed Mayo, director of the New Economics Foundation that has been advising
the government on the scheme, said patients would soon start to notice a
difference.

The foundation hospital trust will still be part of the NHS, providing free
treatment according to need, but it can choose to drop the NHS logo at its
door and on its stationery.

Just inside the main entrance there might be a lifestyle clinic - part of
the trust's attempt to involve the community in a local health partnership.
The clinic will check blood pressure, weight and diet, giving visitors an
opportunity to discuss vitamins, nutrients and exercise.

Opposite the clinic, a noticeboard might carry the election addresses of
local people competing for seats on the hospital's supervisory board. In
some areas the boards will be appointed by local authorities and staff, but
Tony Blair wants to experiment with direct election.

The hospital will be governed by people from its catchment area and will no
longer be accountable to Whitehall.

Patients would quickly notice when the staff uniforms changed as part of the
trust's attempt to learn lessons from other service industries.

They would also spot the cranes around the building. The government believes
that most hospitals have several investment schemes that are economically
viable, but frozen for lack of borrowing permission from the Treasury.

Under the new arrangement, foundation trusts can borrow for any development
that can pay its way, subject to review by an independent regulator.

So the cranes around the foundation hospital in Mr Blair's imagination may
be building a surgical unit or scanner facility and an accommodation block
for nurses.

Paradoxically, these investment schemes are less likely to be private
finance initiatives leading to contracting out of services. Foundation
trusts will be free to borrow where they want.

If the government has got it right, patients would feel a greater vibrancy
and sense of shared purpose among the staff. The concept might not work
well, however, if foundation managers use their greater freedom to pay
themselves fat cat salaries.