Our local hospital sought foundation trust status, but wasn’t considered to be viable on a standalone basis. So, with little other option available, the governing body invited other local FTs to bid to take it over. Clearly the worry for local people is that will lead to ‘asset stripping’, with local services closed. The worry for bidders (and commissioners), meanwhile, is the underlying financial viability of the hospital – there may not be many assets to strip.
What’s now happening is a ‘reverse bidding’ process, where, far from offering a premium to take over our hospital, bidders are naming their price. Presumably if they don’t get a satisfactory offer, they may not bid at all. And that’s the moment when the process would be thrown to open competition. Private bidders could cherry pick the bits they want, and our hospital could be broken up.
This is a really difficult situation, and would have been whichever government was in power. The right balance between the local provision of acute services and the concentration of specialist expertise is always going to be hotly debated. And Trafford General’s financial problems predate the present government. But the way the process is panning out is about to become a real test of ministers’ priorities. For while the bidding negotiations grind painfully on, costs mounts, staff leave, and extra effort is clearly needed to ensure patient safeguarding and quality of care remain centre-stage.
A sensible government, faced with this situation, would see that here the quasi competition model isn’t working well, and step back to rethink. Sat round a table, planning together, the PCT, the hospital board, the potential bidders and patient representatives are confident they’d arrive at a sensible, more cost-effective solution. It might not be the way you’d deal with a struggling industrial conglomerate, but this is the NHS. So will ministers have the courage to recognise that here the market isn’t working, it’s expensive, it’s inefficient, and it may compromise patient care?
Let’s see, for local politicians are seeking a meeting with ministers as a matter of urgency. Lansley’s health bill didn’t create the situation at Trafford, but we’re in danger of its setting the context. I can’t see that competition is offering much of an answer to the challenge of providing quality care for local people as efficiently and effectively as possible. And right now, and very worryingly, I can’t see much sign that patients’ interests – or even GPs’ – are driving the eventual outcome.
I agree wiith Kate’s comments on the dangers of the private sector cherry-picking the easy bits of secondary care. It is puzzling why anyone would think this was a good idea but more mystifying still is the idea that passing the purchasing to GPs will rduce costs. GPs are responsible for most expenditure in the NHS: prescribing, referrals to secondary care and for investigations. Some of us started to reduce unnecessary prescribing, investigations and referrals in the 1960s with great success but no amount of evangelisatism prersuaded most GPs to do the same. Many non-medical friends are advised by their GP practice to ring if anyone has an acute illness such as a sore throat and a presciption for an antibiotic will be left out (saves time for the doctor) and not to bother their GP with anything acute: just go to A & E. It is said that the patients need to be educated: maybe but the doctors need to be obliged to practice as they know they should and not cut corners for a quiet life.
• The point of the exercise is to make GPs ( the keepers of the NHS cheque book – the controllers of demand – the gate keepers ) responsible for their budgets – to be rewarded for keeping within them and sanctioned if not. Start putting others – nurses consultants patients etc – on the boards and the point of change is lost.
Dr Gillian Strube must at one time have had George W. Bush among her patients. ‘Evangelisatism’: I mean, honestly.
My comment earlier today (Dubya and ‘evangelisatism’) looks flippant in a serious matter where Dr Strube argues well. I was exhausted from midnight radio debates that seem to involve the entire UK medical community yet offer nothing to take away. In that mood, a verbal glitch filled the bill.