By Mike Fenwick, Airedale Health UNISON (personal capacity)
Foundation hospitals mean some hospital trusts will be given a greater degree of local autonomy to run their own affairs, including setting their own wage rates, borrowing from the private sector and specialising and expanding as they see fit.
In the first place only hospitals considered to be high performers will be allowed to apply. This means a reintroduction of the Tory internal market into the NHS. Early implementers can concentrate on developing high volume services for simple operations and, such as hip replacements, and create monopolies before their local competitors are allowed to enter the race.
The threat is the creation of a two tier NHS, dominated by a small group of large hospitals.
As 70% of the NHS budget is now to be managed by Primary Care Trusts (PCTs), money will flow to where services are cheaper, to the detriment of established local hospitals and services. Smaller hospitals can only hope to compete effectively for emergency and community based services that have to be provided half way close to home. These are the "efficiencies" of the market where there have to be winners and losers.
Some experts project that some hospitals stand to lose up to 30% of their income as a result of these changes.
There is likely to be a corresponding drift of staff given the continued shortages in key areas such as doctors and nurses if Foundation Trusts are allowed to offer better wages and conditions. This highlights an apparent confusion within the Department of Health, which at the same time is promoting Agenda for Change as a return to national pay and bargaining guaranteeing the future of a truly national NHS.
All the extra money being poured into the NHS has failed to produce the expected gains in activity and productivity. Much of the extra money has been diverted away from patient care into new managers, wage gains for executives, and the financial black hole that is PFI. So Alan Milburn is forced to look back to the Tory reforms of the 1980s as he continues to retain his commitment to a private rather public sector model for the NHS.
There has been opposition within the Labour Party, with the third largest backbench rebellion to date against New Labour on the second reading of the Bill. More opposition is expected during the committee stage. Unison, Amicus and other unions are seeking to launch a broad campaign against these moves, including seeking support from the RCN and BMA.
There is a deep well of public support for the NHS; independent MPs now sit in both the UK and Scottish parliaments as a result of local campaigns in defence of services.
The unions and particularly the left should seek the broadest campaign possible that includes local groups and service users to mobilise opposition to these proposals. The fight against PFI has shown how successful such initiatives can be, though they have remained local phenomena such as in Wakefield and Dudley.
A national campaign can be built if it relies on building public opposition rather than behind the scenes briefings and polite pressure on ministers. The scale of the anti-war movement offers hope for a mass campaign for the NHS.
