Trusts sceptical about NHS freedom

17 Jan 02
NHS managers gave a qualified welcome to this week's announcement giving greater independence to the best trusts but remained sceptical over Alan Milburn's masterplan for a brave new world in the health service.

18 January 2002

The health secretary said three-star trusts would be released from Whitehall control, but managers doubted that ministers and civil servants could truly pull back from the day-to-day running of the NHS. They fear that the reality is unlikely to match the government's rhetoric.

NHS Confederation acting chief executive Nigel Edwards said: 'The government will need the courage of its convictions – history tells us that politicians set out with such intentions to free up the NHS but quickly get nervous and fail to provide the necessary freedoms, for example the freedom to borrow money, retain reserves, take risks and be entrepreneurial, and to determine local pay.'

He added that Milburn should 'be courageous' and liberate the whole of the NHS from Whitehall control, irrespective of the number of stars they had been awarded.

Stuart Marples, chief executive of the Institute of Healthcare Management, said: 'There has been a great deal of frustration about the number of central initiatives and the difficulty of meeting so many objectives. If this promised freedom releases managerial innovation it will be a good thing.'

Last September Milburn said the top-performing three-star trusts would be rewarded with fewer inspections, the ability to set up trading arms and the right to keep the proceeds from the sale of surplus assets.

But he took this a stage further this week with the disclosure that they could become 'foundation' trusts – not-for-profit organisations that may also be free to vary national pay rates.

Charities and universities, as well as other health service management teams and the private sector, could assume the management of persistently failing trusts. Further details of the proposals are expected in the next few months.

South Derbyshire Acute Hospitals Trust, one of the 35 three-star trusts, while not dismissing the 'opportunity' the new plans might eventually provide, said it would continue to concentrate on the modernisation prescribed in the NHS Plan.

'For the foreseeable future we must continue to ensure that patients are at the centre of our service improvement and that we are able to maintain the quality of the care we provide,' a spokesman told Public Finance.

The public service unions Unison and the GMB were predictably indignant, accusing the government of creating a new Railtrack. The Milburn plan, they said, would create a two-tier health service, undermine the NHS national pay structure and lead to fragmentation.


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