[A-List] UK corporate state: unhealthy accumulation

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

On 15 January 2002, I wrote:

At the moment
the NHS is exempt from GATS provision. But the privatisation of NHS
*assets* enables the NHS to become a Canadian-style insurer of first
resort, whilst enabling private companies to take ownership and complete
what would be the first tranche of privatisation. The second would occur
once the insurance industry employed GATS and other legislative weapons
to attack the NHS's insurance monopoly. This could be sold to the
British public as fine were the NHS then to become the Office of the
Health Care Regulator or some such outfit, in which the state would then
act as a guarantor of a minimum level of universal cover (as appears to
have been the model adopted by the World Bank in developing countries)
whilst private companies cream skim the lucrative action and leave
public facilities to wither amid fiscal crisis. Alarmist? Fanciful?
Watch this space.

See http://archives.econ.utah.edu/archives/a-list/2002/msg00170.htm

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Foundation trust regulator sought

Tash Shifrin
Wednesday May 14, 2003

The post of independent regulator for NHS foundation trusts, potentially one
of the most powerful jobs in the health service, has been advertised at a
salary that could top £175,000.

The advert in today's Society Guardian will further stoke the political row
over foundation trusts, which last week sparked a rebellion by more than 60
Labour backbenchers. The health and social care (community health and
standards) bill, which creates the legislative framework for foundation
trusts is now being debated at its Commons committee stage.

The independent regulator will have sweeping powers over future foundation
trusts, setting out the regulatory framework within which they will operate
and setting the terms of authorisation for each foundation.

The post-holder will draw up a "prudential borrowing code" covering all
foundations and set a "prudential borrowing limit" for each one. But in an
apparent snub to the chancellor, Gordon Brown - who has fought to keep
borrowing within Treasury-set limits - the job specification says the
regulator should "not aim to set prudential borrowing limits so tightly as
to negate NHS foundation trusts' freedom to manage".

The code will be established after consultation with the health secretary
and "every NHS trust intending to apply for foundation status".

The independent regulator "will not become an alternate source of line
management for NHS foundation trusts, replacing the Department of Health",
the job description promises. But although foundations will have wide
freedoms to determine what services are provided and to sell off assets, the
regulator will lay down which assets and services must be "protected" and
retained. . The regulator will also decide the proportion of a foundation
trust's total income that can be derived from private patients, subject to
provisions in legislation.

They will also have strong powers to intervene where trusts are failing or
breaking the terms of their authorisation, including powers to appoint
"interim management or insolvency administrators" to take over the running
of the trust. The regulator will also be able to sack the board or "in
extremis" revoke the foundation's licence.

The regulator could become one of the most powerful figures in the health
service if - as the health secretary, Alan Milburn has suggested - all
hospitals become foundations over the next five years.

Information for candidates compares the independent regulator's relationship
with ministers with that of the charity commission, financial services
authority or inland revenue.

The salary for the post is "likely to be in the range" of £150,000-£175,000,
but more could be offered. The postholder could also opt for a four-day
week.

Because legislation to create foundation trusts and the regulator post has
not yet been passed by parliament, the successful candidate will initially
be appointed as an advisor to the health secretary.

Candidates are expected to have a background at chief executive or finance
director level or in a role providing both professional and managerial
leadership in a professional service or regulatory organisation.

They could have experience of either the private or public sector, while "a
combination of both might be particularly valuable". Experience directly
relevant to the NHS is described as "helpful but not essential".