The Socialist Health Association considers that there are fundamental flaws in proposals for Foundation Hospitals:
1. The proposal for democratic stakeholders is entirely unworkable in the context of a big hospital because of the lack of a genuine catchment area. The interests of the local population – pretty deprived in the case of many teaching hospitals – are in opposition to the patients attending specialist units who come from further away. Local people and organisations are likely to dominate stakeholder boards, and they could quite rationally decide to close down expensive regional services and divert the resources to meet local needs.
2. A hospital is entirely the wrong unit to empower. If we gave the local population a democratic voice it should relate to its Primary Care Trust which has an interest in all local services and relates to a geographical area. PCTs should be accountable to their local community. Hospitals serve a wider community. We should not be trying to increase the political importance of hospitals especially if, as in the case of many smaller hospitals, it is likely that they will have to be closed or reconfigured in the foreseeable future. Big teaching hospitals have plenty of power and influence already. They do not need more. They are run by powerful doctors who are likely to dominate local volunteers.
3. Given the low level of public participation how would we prevent pressure groups like anti-abortionists or advocates of particular treatments or conditions taking over their local hospital? Are stakeholders to be vetted?
4. The effect of the first wave of foundation hospitals in a situation of prolonged staff shortage seems likely to boost recruitment at a small number of institutions at the expense of the rest of the NHS. The government appear in the NHS financial reforms of October 2002 to be reintroducing the internal market in the health service which they claimed to have abolished. Foundation hospitals are clearly going to compete for resources and for patients. The reassurances made about poaching staff are meaningless. A hospital with more resources can offer to employ staff on higher scales, or on more attractive terms which its struggling neighbours cannot match. Next year, we suppose, the foundation hospitals will recruit the brightest and keenest staff to expand their operations, thereby making it even less likely that any of the hospitals left behind will achieve foundation status. Within quite a short time market forces may force some specialist units to close.
5. Reports of the Spanish experience with foundation hospitals are not encouraging.
6. The effect of encouraging consumer choice in schools has been that the poorest schools enter a spiral of decline from which they cannot recover. Is there any reason to suppose this will not happen with hospitals?
7. The future of the NHS is all 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.