N e w s f r o m C a t a l y s t
2 4 M a r c h 2 0 0 3
Included in this mailing:
1. FOUNDATION HOSPITALS BILL - full analysis at www.catalystforum.org.uk
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1.
FOUNDATION HOSPITALS AND THE FUTURE OF THE NHS
By John Mohan
"UNISON shares many of the fears raised in this insightful paper about
Foundation Hospitals. I have no doubt that Foundation Trusts will lead to
increased privatisation, higher costs and damaging competition in the NHS."
- Dave Prentis, General Secretary, UNISON
Legislation to create Foundation Hospitals is currently being rushed through
parliament, opening what former health secretary Frank Dobson has called "a
second front against party members and affiliated trade unions" in midst of
a controversial war.
Today Catalyst publishes an important paper by Professor John Mohan of
Portsmouth University, an expert on the history and geography of health care
restructuring and the author of "Planning, Markets and Hospitals" (Routledge
2002), which argues that the current Bill has the potential to undermine an
efficient, integrated and equitable national health service, free at the
point of use and planned according to social need.
Despite concessions to critics of the original proposals contained in the
Bill, Professor Mohan argues that the the institution of Foundation Trusts
will result in significant distortions and inequities in the allocation of
investment, revenues and trained staff; a vague regulatory regime and
superficial structures of mutualism and accountability will do little to
restrain the powerful dynamics of competition, commercialisation and
privatisation that will be unleashed.
Among the paper's key findings are:
* that prior to hospital nationalisation in the 1940s "there were fivefold
variations in your chances of obtaining treatment in a voluntary hospital,
depending on where you lived". The much maligned era of "top down"
planning - that is, strategic direction of investment and service provision
to meet social need - was vital to reducing health inequalities during the
post-war period
* that the reputed Treasury/Department of Health compromise over Foundation
Trusts' borrowing powers could still "distort the prioritisation of capital
projects in the NHS", and Foundation Trusts' retention of the proceeds of
"unprotected" asset disposals will mean that public revenues are distributed
according to "accidents of geography"
* that experience overseas shows that competitive systems put pressure on
not-for-profit hospitals to "abandon their community orientation" and "act
in a commercial manner". Supposedly representative governing bodies will
most likely be reduced to "providing a rubber stamp for business strategies
which are devised by managers and medics"
* that "segregation in the clientele using hospitals" may result from
Foundation Trusts' attempt to avoid expensive caseloads by selecting
according to demographic profile. Foundation Trusts may also seek to
generate revenue by putting "unprotected" assets (eg car parks and retail
property) to commercial use, imposing higher costs on patients, visitors and
staff
* that the effect of the Independent Regulator may be to increase scope for
user charges and "entrench the role of the private sector as the main
provider of aspects of NHS care in some locations"
The paper concludes that the current direction of policy is informed more by
pragmatism than principle, resulting in "a dangerous drift" back towards the
uneven patchwork of services that characterised the pre-NHS era. It might
actually be bolder, Professor Mohan suggests, to return to principled
arguments for integrated, egalitarian public services and concentrate on how
to improve the NHS within that framework.
The paper can be downloaded in full today as a PDF by visiting
http://www.catalystforum.org.uk/pubs/pub9.html. Limited hardcopies are
available on request from the Catalyst office (020 7733 2111). An executive
summary is at http://www.catalystforum.org.uk/pubs/pub9a.html.
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'Reconciling Equity and Choice?
Foundation Hospitals and the future of the NHS'
By John Mohan
A Catalyst working paper
Published in March 2003
ISBN 0 904508 04 9
30 pp
http://www.catalystforum.org.uk/pubs/pub9.html
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