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Freed hospitals dare not fail
Surgery
Hospitals are being promised new freedoms

Imagine it is early January 2003. A local newspaper in Cambridge has published photographs of bodies strewn around the floor of the chapel at Addenbrooke's Hospital.

The media and the opposition are in full cry. There are calls for an inquiry. The health secretary is dragged to the House of Commons to explain.


Mr Milburn claimed he would be able to resist the temptation to interfere

What does he say? 'It is nothing to do with me?'

Addenbrooke's is one of four NHS trusts which the Health Secretary Alan Milburn said this week are likely to become the first NHS Foundation Trusts.

We do not know exactly what that means yet. The civil servants are still trying to work out what changes in the law will be needed to bring it about.

The principles behind it are clear enough though. Earned autonomy is what Mr Milburn calls it.

New freedoms

The best in the NHS should be freed from the shackles of the Whitehall machine to innovate and improve the service they offer their patients.

Crucially the Health Secretary has announced his intention to give up his legal powers to direct these trusts to do as he says.

Instead they will be regulated by the new Commission for Healthcare Audit and Inspection who will also incidentally decide which hospitals can apply for Foundation status - and potentially who loses it if they start to fail.

Which brings us back to the bodies in the chapel.

Mr Milburn sat in front of a clutch of journalists after his speech this week and with a perfectly straight face claimed he would be able to resist the temptation to interfere in such a situation.

In fact, he said, he would be pleased not to have to.

Do you believe him?

Interference


If the managers of Foundation hospitals really are the best in the service perhaps the first few should be left to get on and make it up as they go along

Ask the chief executive of another hospital likely to be in the first tranche of Foundation hospitals who told us how the bureaucrats from NHS Estates were still interfering with the plans for her new building the day the contracts were due to be signed.

Or the delegates at the conference who pleaded with the civil servants later in the day not to make the system too prescriptive but just to let them get on with it and try to make it work.

Or the consultant who told one of my colleagues that after he made controversial comments about the NHS the chief executive of his hospital was warned in a phone call from 'the centre' that unless he kept his people in line certain funds he was expecting might not arrive.

The Conservatives said the announcement this week raised more questions than it answered.

That may not be a bad thing.

If the managers of Foundation hospitals really are the best in the service perhaps the first few should be left to get on and make it up as they go along in a spirit of true entrepreneurship.

Ignoring, of course, the admonishment from Richmond House made in private to a senior health service manager that: "We do not tolerate failure".

So the message to these Chief Executives is clear.

Bravely take risks and see what you can do in the brave new world of public interest companies, prudential borrowing, staff bonuses and incentives.

Just do not get it wrong. No pressure, eh?

See also:

22 May 02 | Health
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