Foundation Trusts and Mutuality

I have recently rejoined the Socialist Health Association and was pleased to receive the July/August 2003 issue of Socialism and Health.

The topic of foundation trusts for the National Health Service is clearly of great interest and importance. As somebody who has been advocating healthcare mutuals, and involved with what is now the foundation trusts debate over the last three years, I would like to comment on several of the remarks reported in this “Foundation Hospitals Special”.

First, any suggestion that prospective foundation trusts go for any sort of token membership should most certainly not go unchallenged. To truly involve people in the oversight of the NHS will involve harnessing their collective energy. Any moves to restrict membership or other forms of engagement would perpetuate the somewhat inward-looking and rather patronising attitudes all too prevalent in the NHS. (When a while ago I heard a Primary Trust Chair recoil in horror at the suggestion that “hoi polloi” would get on trust boards, it made me more determined that such views must be defeated.)

Second, I agree that the Local Government Association seems to be seeking to set the clock back by arguing that local government councillors are being bypassed as the Government looks at new ways of running public services. Councillors have important roles, to be sure, but it is special pleading to be asking that they would have automatic rights of representation on NHS trust boards. Councillors have their own problems to attend to, and there are already far too many multiple holders of quango and similar positions, when they should be devoting more time to their own organisations.

Third, to refer to social ownership models associated with “quasi-mutual co-operatives” as “meaningless” is nonsense. It not only insults the mutual and co-operative sector, but also entirely misses the point about many of the deliberations around the Government’s intentions to model the governance of foundation trusts on co-operative societies and other mutuals (1). The United Nations undertook a survey of health and social care mutuals worldwide, published in 1997 (2). It would be arrogant and insular to assert that overseas healthcare mutuals are any less “meaningful” in their governance arrangements than are other forms of healthcare delivery, including the present NHS. People from the British co-operative movement and other mutuals are already in discussion with senior NHS directors and managers to bring the experiences of running large and complex democratically controlled organisations to bear on NHS thinking.

I remarked earlier that the NHS is too inward looking. One example of that comes out in certain statements from the House of Commons Health Committee, along the lines of how awful it would be if the distribution of hospital services were to alter on account of the introduction of foundation trusts. Whose health service is it anyway? Many people have argued that it suffers from too much “producer capture” (to use an economist’s term) already. The fear of change has much in common with the top-down mentality that the Government is trying to get rid as it tries to make the NHS more responsive to people, not having them sit there and be told what their needs are.

The reported outcome of the SHA May 24 seminar on foundation trusts – it was agreed that “the government has reformed the NHS sufficiently for it to improve to the levels required” – is astonishing. No, the Government is correct in its view that funding must be accompanied by reform. To assume that the NHS is perfect or pretty well on its way to perfection shows a gross disregard for the views of the many millions of people who currently use and fund the NHS as it is.


(1) A Guide to NHS Foundation Trusts, Department of Health, London, December 2002.

(2) Cooperative Enterprise in the Health and Social Care Sectors A Global Survey, United Nations, New York, 1997.

Yours sincerely,

Geraint Day

Member, Co-operative Party National Executive Committee

2003 August 21