UNISON on Foundation Hospitals in Sheffield
Report by Bill Ronksley
Published: 05/11/03
Address on Foundation Hospitals to Sheffield TUC by Keith Woods, Regional Officer, Yorkshire & Humberside, UNISON
For most of us Foundation Hospitals came out of the blue. We had not heard about them - it came ‘out of the blue’. We had not debated them and we did not know anything about them. They were suddenly announced in Parliament in January, 2002, by the former Secretary of State for Health, Alan Milburn.
For a thing like that it should be debated through the Labour Party, through various groups, through the Trade Union Movement, and etc., before it actually got to Parliament. But it did not. Alan Milburn went on a tour of Spain, Sweden, and Denmark, looking at their health services. Of course, what he did not do, and what he should have done, before introducing anything like this, was to consult with interested parties. What he did not do before coming up with an idea like this was to come up with the amount of money that the Governments in Spain, Sweden, and Denmark, put into their health services per head of the population. We put far less money in than they do.
We have been in touch with the trade unions in those countries where Foundation Hospitals were started and, believe it or not, a couple of years into it they are saying it is a bad idea and they are trying to come out of it just as we are going into it. So, that is where we are. There is massive opposition to Foundation Hospitals in this Country.
Most, if not all, the trade unions are against them. Quite a lot of M.P.s. voted against it the last time round - and a lot of M.P.s. abstained. It was only carried at the end of the day on the vote of the Scottish M.P.s. who it did not directly affect. Doctors, consultants, the Labour Party Conference, and lots of other people are all coming out and saying they are against Foundation Hospitals.
Still, the Government is forging ahead with Foundation Hospital Trusts. Tony Blair‘s Government is dictating to all the NHS Trusts that they must become NHS Foundation Hospitals within the next four years.
It started off with the first work, which is due to start in April next Year. It will have a three star rating and will be one of the top hospitals afforded Foundation Hospitals Status. It has now got to the situation where at the back end of the four years he (the present Secretary of State for Health) is not really bothered whether they have got any star ratings at all or whether they are performing well, or not, he is pushing them into that situation.
The Sheffield Teaching Hospital, which is made up of the following hospitals - the Royal Hallamshire, Northern General, Jessops, Weston Park, and Charles Clifford - employ over twelve thousand people and has a catchment area of two million - applied to become a Foundation Hospital within the first wave.They could, if everything goes to their plans, be a Foundation Hospital by April of next Year.
Currently, within the Consultation period and certainly within that Consultation Period this Consultation Document, which has been seen by very few people, has to be discussed. I have a spare copy of it here should anyone wish to see it. Normally, in the National Health Service, where there are any major changes, there has to be a three months Consultation Period. Then, after the Consultation Period all comments on the changes have to be taken on board before there is movement forward on implementing the proposed changes.
This Consultation Period has been shortened by the Government from three months to ten weeks. The Consultation Period started ten days before the document was ready. We were two weeks into it before anyone had seen the documents containing the proposals. The Consultation Period finishes on the 30th of this Month (October). This is the timescale we are talking about - they are whipping it through very fast.
But, of course, the legislation has not yet been Passed by Parliament. We are in the situation where they have decided to go ahead and where the Consultation Period will have shortly been concluded but where Parliament has not yet decided whether, or not, to approve Foundation Hospitals. At the present time the proposed legislation is going through the House of Lords and through the Committee Stages and day by day new amendments to the proposed legislation are coming through.
They are so keen to get the proposed legislation through they are agreeing to changes to same. It then goes back to the House of Commons and we are told it has to receive Royal Assent by 17th November. If it does not receive Royal Assent then the whole Foundation Trust Debate will fall off the Parliamentary Agenda.
You will be aware that the recent Labour Party Conference voted against Foundation Hospitals and some of you may have heard Tony Blair‘s speech in which he said he has ‘no reverse gear’. He can only go forward. Well, my response to that is we are not asking him to go in reverse - we are asking him to go slightly to the left.
The Consultation Document, on Page 12 says: ‘The NHS Foundation Trusts will remain part of the NHS Family, will account for their performance to local people, and to an Independent Regulator, and not to The Department of Health.’ So, we are to be divorced from The Department of Health and stand alone and supposedly be accountable to the people of Sheffield. What does it mean by ‘local accountability’?
Well, what they intend to do is to set up a Governing Council which will be made up of thirty seven Governors. The legisliation presently going through Parliament says at least 51% of those Governors must be elected, or drawn from Public and Patient Trust Members. So, of the thirty seven Governors nineteen will be patient and public Governors, thirteen Stakeholder Governors will be nominated by Chosen Groups from The Trust Board, and there will be five Staff Governors.
But out of the thirty seven Governors the thirteen Stakeholder Governors will all be selected by each of the Stakeholder Groups. Whichever the Stakeholder Group is they will nominate their own person - there will be no ballot - no vote - no election. Of the nineteen Public and Patient Governors twelve of them will be Local Residents made up of three from each of the four Primary Care Trusts in the City and they will be identified by their Post Codes, and seven will be nominated from but not elected by other Patient User Groups.
So, only twelve of those nineteen will be elected by Trust Members. There will also be the five Staff Governors who will not be nominated from the Trade Unions but can be self-nominated by any member of staff within those groups. All five of those will be elected by the Staff Members, but only by Staff Members who choose to be Trust Members.
So, out of the thirty seven Governors only seventeen will be elected by the Trust Members. Trust Members are people who apply to The Foundation Trust to become Individual Members of The Foundation Trust and are drawn from two main groups. The first Group will be the Patients and Public Members Group from the Public Catchment Area of up to two million people; and the twelve thousand staff who work for the Foundation Trust is the other one. Each Group may only vote for people within their Group.
Trade Union Members who work for the Foundation Trust are also users of services provided by the Foundation Trust, and so are their families, but they will not be allowed to stand for two Groups - they will only be allowed to stand for one Group. They may choose which one to apply, for but they may not apply for two.
The Consultation Document, on Page 12, suggests that they hope to have one thousand members eligible to vote for seventeen of the Elected Governors by February/March of next Year. We are told that with a potential membership of between one and a half million and two million - and if we are generous we can call it a potention membership of one million - only one tenth of one per cent will be eligible to vote for the Governors.
They call that ‘Local Democracy !’ Well, I do not thinks so - do you? When elected the Governors will have no powers. They cannot make any decisions and they can only recommend to the Trust Board because the Trust Board will still be in existence. They cannot even elect their own Chairperson. The Chairperson will be the Chairperson of the Trust who is nominated by the Government. They (the Governors) will only meet three times a year.
The Trade Unions, at a recent meeting, asked the Project Manager what would be the role of the Governing Body to The Trust Board and could the Trust Board ignore recommendations made by the Governors and they were told the Board could ignore such recommendations if it so wished. What local democracy is there if the Board can ignore them?
UNISON also believes Foundation Hospitals will lead to a two tier Health Service. The documentation makes it clear that Foundation Hospitals will have to carry out health care free at the point of delivery. So, what is the problem? Well, Foundation Hospitals will be free to offer patients satellite television, videos, telephones, private rooms, better food, maybe wine, private bathrooms, personal services, hairdressers, plus many more things. In fact, anything that patients can afford to pay for.
UNISON says, in no uncertain terms, that all these extras, if they are going to be provided, should be provided for everybody free of charge and we should not have a two tier system. It is clear that that is what we will finish up with with Foundation Hospitals.
How will Foundation Hospitals be funded? There is no new money coming from the Health Service for Foundation Hospitals - they are going to have to generate their own funds. They are to have freedom to borrow money - they have that freedom now. They have got freedom to borrow on the Market - to mortgage the future and repay it over twenty or thirty years.
So far as the main funding is concerned there is to be a New Tariff System which is currently being worked on throughout the Health Service where every operation or procedure is being costed down to the last Penny. That information is being fed nationally and it will then be averaged out and that then will be the tarriff for every operation, or procedure, that will be carried out. Some will be good for the Foundation Trusts but some will not be very good for the Foundation Trusts, so, they will not want to bother with services which are not very good. UNISON has raised this issue and told them that it is ‘a load of rubbish’.
What they will do in Foundation Hospitals is that they will increase the lucrative work and decrease the less lucrative work in order, at the end of the day, to make a profit. I am sure you will agree it is disgraceful to make a profit out of someone who is ill. But that is what they are trying to do. What will happen to the patient who requires an operation but their tariff would mean a financial loss to the Foundation Hospitals? It would mean the patient would go to the bottom of the list - would have to wait longer for the operation.,or the patient may be told this operation could not be done in Sheffield but could be done in Wales, or Scotland, or Germany, or France, or Belgium, or somewhere like that. Some people would be left to suffer in silence but that is where we come in as the Trade Union Movement as the voice for those people.
This tariff system, which is to be introduced, will be detrimental to the patients, certainly the poor end of the patients who are not able to afford to pay for a better service.We believe Foundation Hospitals will lead to privatisation. There is nothing in principle in the documentation, in the legislation that is going through Parliament, or these documents that I have here, that stops an organisation such as BUPA or one of the big American or South African companies moving in and taking over the running of the hospitals.
This is not just trade union scare mongering because already this Labour Government has given licences to American and South African companies to run Diagnostic and Treatment Centres in this Country. In fact, this Area will have a Diagnostic and Treatment Centre run by a South African company just off the Motorway near Balby. Friends of yours may be sent there for treatment in the future. Of course, they will have the tariff which they will take along with them.That is privatisation - that is back door privatisation of the NHS.
Once this is established, who in a few years time, will complain if the Northern General Hospital, or the Royal Hallamshire Hospital, are taken over by one of these private companies? This is the drip - the back-door method to privatise the NHS that this Labour Government is adopting.
Those of us who were around during the Tory Years recall we spent eighteen years fighting them to keep the NHS the way it is now. In Sheffield we won nearly every battle that we fought on the privatisation front when they were trying to privatise catering, the laundry services, and all those kind of things. But now we have a Labour Government which is trying to do what the Tories failed to do. We hope you will join with us in our Campaign to stop Foundation Hospitals coming to Sheffield. We can win this battle, but only with your support. This is not just UNISON‘s fight. This fight is for the future of the NHS as we know it.
Report by Bill Ronksley
Published: 05/11/03
Address on Foundation Hospitals to Sheffield TUC by Keith Woods, Regional Officer, Yorkshire & Humberside, UNISON
For most of us Foundation Hospitals came out of the blue. We had not heard about them - it came ‘out of the blue’. We had not debated them and we did not know anything about them. They were suddenly announced in Parliament in January, 2002, by the former Secretary of State for Health, Alan Milburn.
For a thing like that it should be debated through the Labour Party, through various groups, through the Trade Union Movement, and etc., before it actually got to Parliament. But it did not. Alan Milburn went on a tour of Spain, Sweden, and Denmark, looking at their health services. Of course, what he did not do, and what he should have done, before introducing anything like this, was to consult with interested parties. What he did not do before coming up with an idea like this was to come up with the amount of money that the Governments in Spain, Sweden, and Denmark, put into their health services per head of the population. We put far less money in than they do.
We have been in touch with the trade unions in those countries where Foundation Hospitals were started and, believe it or not, a couple of years into it they are saying it is a bad idea and they are trying to come out of it just as we are going into it. So, that is where we are. There is massive opposition to Foundation Hospitals in this Country.
Most, if not all, the trade unions are against them. Quite a lot of M.P.s. voted against it the last time round - and a lot of M.P.s. abstained. It was only carried at the end of the day on the vote of the Scottish M.P.s. who it did not directly affect. Doctors, consultants, the Labour Party Conference, and lots of other people are all coming out and saying they are against Foundation Hospitals.
Still, the Government is forging ahead with Foundation Hospital Trusts. Tony Blair‘s Government is dictating to all the NHS Trusts that they must become NHS Foundation Hospitals within the next four years.
It started off with the first work, which is due to start in April next Year. It will have a three star rating and will be one of the top hospitals afforded Foundation Hospitals Status. It has now got to the situation where at the back end of the four years he (the present Secretary of State for Health) is not really bothered whether they have got any star ratings at all or whether they are performing well, or not, he is pushing them into that situation.
The Sheffield Teaching Hospital, which is made up of the following hospitals - the Royal Hallamshire, Northern General, Jessops, Weston Park, and Charles Clifford - employ over twelve thousand people and has a catchment area of two million - applied to become a Foundation Hospital within the first wave.They could, if everything goes to their plans, be a Foundation Hospital by April of next Year.
Currently, within the Consultation period and certainly within that Consultation Period this Consultation Document, which has been seen by very few people, has to be discussed. I have a spare copy of it here should anyone wish to see it. Normally, in the National Health Service, where there are any major changes, there has to be a three months Consultation Period. Then, after the Consultation Period all comments on the changes have to be taken on board before there is movement forward on implementing the proposed changes.
This Consultation Period has been shortened by the Government from three months to ten weeks. The Consultation Period started ten days before the document was ready. We were two weeks into it before anyone had seen the documents containing the proposals. The Consultation Period finishes on the 30th of this Month (October). This is the timescale we are talking about - they are whipping it through very fast.
But, of course, the legislation has not yet been Passed by Parliament. We are in the situation where they have decided to go ahead and where the Consultation Period will have shortly been concluded but where Parliament has not yet decided whether, or not, to approve Foundation Hospitals. At the present time the proposed legislation is going through the House of Lords and through the Committee Stages and day by day new amendments to the proposed legislation are coming through.
They are so keen to get the proposed legislation through they are agreeing to changes to same. It then goes back to the House of Commons and we are told it has to receive Royal Assent by 17th November. If it does not receive Royal Assent then the whole Foundation Trust Debate will fall off the Parliamentary Agenda.
You will be aware that the recent Labour Party Conference voted against Foundation Hospitals and some of you may have heard Tony Blair‘s speech in which he said he has ‘no reverse gear’. He can only go forward. Well, my response to that is we are not asking him to go in reverse - we are asking him to go slightly to the left.
The Consultation Document, on Page 12 says: ‘The NHS Foundation Trusts will remain part of the NHS Family, will account for their performance to local people, and to an Independent Regulator, and not to The Department of Health.’ So, we are to be divorced from The Department of Health and stand alone and supposedly be accountable to the people of Sheffield. What does it mean by ‘local accountability’?
Well, what they intend to do is to set up a Governing Council which will be made up of thirty seven Governors. The legisliation presently going through Parliament says at least 51% of those Governors must be elected, or drawn from Public and Patient Trust Members. So, of the thirty seven Governors nineteen will be patient and public Governors, thirteen Stakeholder Governors will be nominated by Chosen Groups from The Trust Board, and there will be five Staff Governors.
But out of the thirty seven Governors the thirteen Stakeholder Governors will all be selected by each of the Stakeholder Groups. Whichever the Stakeholder Group is they will nominate their own person - there will be no ballot - no vote - no election. Of the nineteen Public and Patient Governors twelve of them will be Local Residents made up of three from each of the four Primary Care Trusts in the City and they will be identified by their Post Codes, and seven will be nominated from but not elected by other Patient User Groups.
So, only twelve of those nineteen will be elected by Trust Members. There will also be the five Staff Governors who will not be nominated from the Trade Unions but can be self-nominated by any member of staff within those groups. All five of those will be elected by the Staff Members, but only by Staff Members who choose to be Trust Members.
So, out of the thirty seven Governors only seventeen will be elected by the Trust Members. Trust Members are people who apply to The Foundation Trust to become Individual Members of The Foundation Trust and are drawn from two main groups. The first Group will be the Patients and Public Members Group from the Public Catchment Area of up to two million people; and the twelve thousand staff who work for the Foundation Trust is the other one. Each Group may only vote for people within their Group.
Trade Union Members who work for the Foundation Trust are also users of services provided by the Foundation Trust, and so are their families, but they will not be allowed to stand for two Groups - they will only be allowed to stand for one Group. They may choose which one to apply, for but they may not apply for two.
The Consultation Document, on Page 12, suggests that they hope to have one thousand members eligible to vote for seventeen of the Elected Governors by February/March of next Year. We are told that with a potential membership of between one and a half million and two million - and if we are generous we can call it a potention membership of one million - only one tenth of one per cent will be eligible to vote for the Governors.
They call that ‘Local Democracy !’ Well, I do not thinks so - do you? When elected the Governors will have no powers. They cannot make any decisions and they can only recommend to the Trust Board because the Trust Board will still be in existence. They cannot even elect their own Chairperson. The Chairperson will be the Chairperson of the Trust who is nominated by the Government. They (the Governors) will only meet three times a year.
The Trade Unions, at a recent meeting, asked the Project Manager what would be the role of the Governing Body to The Trust Board and could the Trust Board ignore recommendations made by the Governors and they were told the Board could ignore such recommendations if it so wished. What local democracy is there if the Board can ignore them?
UNISON also believes Foundation Hospitals will lead to a two tier Health Service. The documentation makes it clear that Foundation Hospitals will have to carry out health care free at the point of delivery. So, what is the problem? Well, Foundation Hospitals will be free to offer patients satellite television, videos, telephones, private rooms, better food, maybe wine, private bathrooms, personal services, hairdressers, plus many more things. In fact, anything that patients can afford to pay for.
UNISON says, in no uncertain terms, that all these extras, if they are going to be provided, should be provided for everybody free of charge and we should not have a two tier system. It is clear that that is what we will finish up with with Foundation Hospitals.
How will Foundation Hospitals be funded? There is no new money coming from the Health Service for Foundation Hospitals - they are going to have to generate their own funds. They are to have freedom to borrow money - they have that freedom now. They have got freedom to borrow on the Market - to mortgage the future and repay it over twenty or thirty years.
So far as the main funding is concerned there is to be a New Tariff System which is currently being worked on throughout the Health Service where every operation or procedure is being costed down to the last Penny. That information is being fed nationally and it will then be averaged out and that then will be the tarriff for every operation, or procedure, that will be carried out. Some will be good for the Foundation Trusts but some will not be very good for the Foundation Trusts, so, they will not want to bother with services which are not very good. UNISON has raised this issue and told them that it is ‘a load of rubbish’.
What they will do in Foundation Hospitals is that they will increase the lucrative work and decrease the less lucrative work in order, at the end of the day, to make a profit. I am sure you will agree it is disgraceful to make a profit out of someone who is ill. But that is what they are trying to do. What will happen to the patient who requires an operation but their tariff would mean a financial loss to the Foundation Hospitals? It would mean the patient would go to the bottom of the list - would have to wait longer for the operation.,or the patient may be told this operation could not be done in Sheffield but could be done in Wales, or Scotland, or Germany, or France, or Belgium, or somewhere like that. Some people would be left to suffer in silence but that is where we come in as the Trade Union Movement as the voice for those people.
This tariff system, which is to be introduced, will be detrimental to the patients, certainly the poor end of the patients who are not able to afford to pay for a better service.We believe Foundation Hospitals will lead to privatisation. There is nothing in principle in the documentation, in the legislation that is going through Parliament, or these documents that I have here, that stops an organisation such as BUPA or one of the big American or South African companies moving in and taking over the running of the hospitals.
This is not just trade union scare mongering because already this Labour Government has given licences to American and South African companies to run Diagnostic and Treatment Centres in this Country. In fact, this Area will have a Diagnostic and Treatment Centre run by a South African company just off the Motorway near Balby. Friends of yours may be sent there for treatment in the future. Of course, they will have the tariff which they will take along with them.That is privatisation - that is back door privatisation of the NHS.
Once this is established, who in a few years time, will complain if the Northern General Hospital, or the Royal Hallamshire Hospital, are taken over by one of these private companies? This is the drip - the back-door method to privatise the NHS that this Labour Government is adopting.
Those of us who were around during the Tory Years recall we spent eighteen years fighting them to keep the NHS the way it is now. In Sheffield we won nearly every battle that we fought on the privatisation front when they were trying to privatise catering, the laundry services, and all those kind of things. But now we have a Labour Government which is trying to do what the Tories failed to do. We hope you will join with us in our Campaign to stop Foundation Hospitals coming to Sheffield. We can win this battle, but only with your support. This is not just UNISON‘s fight. This fight is for the future of the NHS as we know it.
