Why foundation trust

No one is saying that there is malpractice but what a recipe for potential disaster. Openness, fairness etc etc - how do you convince anyone that this is going on? Little is heard of their demands, desires or otherwise to expose when problems are finally aired nationwide.

How many sit there hood winked through presentations by Trusts and nod pleasantly in the Trusts direction having first put on their rose coloured specs? Well meaning people I have no doubt but they are our direct representatives I worked in a Trust determined to get Foundation status and it was all about balancing the books; quality of service was low on their agenda and some services suffered to the extent that they have never recovered.

Trusts nationally told the DOH that they needed fewer nurses cost saving again , training numbers were decreased and they are now having to fill gaps with expensive agency staff. Yet another example of how top-down reforms have had a malign effect and wasted billions of pounds. I agree, this is a depressing turn of events. General Motors aside, many countries successfully blend public and private provision without needing to dominate or nationalise; the benefit for patients and outcomes is evident in superior clinical outcomes.

I agree with N Goodwin that the trusts may have planted the seeds of their destruction through timidity. But Milburn's original Spainish insight was transformed into a pale model of independence. Elsewhere, Canada's hospitals, while creatures of provincial legislature, broadly enjoy high levels of independence despite a monopsony payer; Germany has successful hospitals as does France and the Netherlands; Malaysia is the home to IHH, the world's second largest hospital chain; do we need to mention the US?

And so it goes. All operate within both public and private healthcare systems. If I were looking around for world-class hospitals, there are higher performing models in other countries, what lessons would I gather from the NHS? It sometimes seems amateurish. The current state of affairs may be more a pecularity to how the NHS mandarins worry about their own response to crises.

Fear drives actions such as we're seeing and the consequence is to constrain managerial freedoms to innovate, which in the end provides the evidence that state intervention was needed in the first place.

Even the most ambitious organisations eventually learn to stop struggling when the regulatory and bureaucratic chains become too heavy. All I can reflect back is that if freedoms are good for prison or school governors, what is the problem with hospitals. Such policy incoherence is breathtaking. This analysis is depressingly accurate and a similar account could have been given for why NHS Trusts didn't achieve their greater freedoms when they were created in the early s.

The current situation is compounded by at least two interrelated factors alluded to in the blog. First, the failure of the majority of FTs to realise the benefits from their greater freedoms in the early days of the FT movement.

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