To Be or Not to Be

The Central Manchester and Manchester Children's University Hospital Trust (CMMCUH), currently a Primary Care Trust, is making a bid to become a Foundation Trust.

I summarised the official definitions of the various types of financial/administrative status of the different “units” of our “socialised” healthcare system here. Sorry international readers for having to make you navigate the ways and means of English health service bureaucracy .

Such a change in status may, I will admit, be advantageous to the Trust itself. But not necessarily advantageous to the National Health Service as a whole.

UNISON, the trade union for public service workers including many in the National Health Service, objects to the concept of foundation trusts for several reasons which are outlined here and here.

I will only elaborate on some of them as they pertain to Manchester and other trusts in the north west region.

A key concept of foundation trusts is that they will be able to keep any financial surpluses they generate rather than hand it back to the overall NHS “pot” out of which the NHS is financed. A foundation Trust will be able to sell off capital assets and keep the profits. The foundation trust will be able to contract out services (including medical services) to private companies, who are more interested in patient volume (as they will be paid by this) than quality-of-care, without consulting a central authority. This will generate a “class division” between foundation trusts and poorer trusts not eligible for foundation trust status on various criteria but including profitability potential.

Although I somewhat agree that the CMMCUH's Royal Manchester Children's Hospital, Booth Hall Children's Hospital etc need to be replaced as old Victorian “unsanitary”, “difficult-to-maintain” buildings, I am now somewhat cynical about the trust's motive in building new children's (and other) facilities on its principal site in central Manchester – first, plan a brand-spanking new hospital, become a foundation trust and then sell-off the desirable suburban old (and, I will say, to-our-mental-health, comforting) hospital sites and keep the profits. And the government will say “oooh ... you're in the black, so we don't need to give you so much money”.

And who is currently paying for Kezia's leukaemia treatment? Not the CMMCUH to which her treatment centre belongs, but the Pennine Acute Hospitals Trust (a primary care trust) which is having to close services at district general hospitals to make ends meet.

Ok, that's the first gripe over – now onto the second.

“Membership” - in the consultation document (and more on that below!), they want 12,000 public and 8,000 staff to become “members”. The 20,000 “members” will represent John-and-Jane Public and Jane-and-John Staff. Between us, we will elect 33 governors. Of these 33 governors, 2 will be Local Authority representatives, 2 will be Greater Manchester residents and 2 can be from anyone in England and Wales (hey, I can just imagine becoming a foundation trust governor groupie elected to every England and Wales foundation trust!).

None of the 33 governors will be British Medical Association members (representing doctors), none will be Remedy UK (representing trainee doctors), none will be Royal College of Nursing reps., none will be local GP reps. and none will be UNISON (representing the cleaners, porters, kitchen workers etc).

The Governors in turn will elect some of the Board of Directors. The Governors can select the five to nine non-Executive Directors including the Chair, and then there are 5-9 Executive and non-elected Directors. In the consultation document it is not explained how and by whom the Executive Directors are selected nor whether the 5-9/9-5 balance between Executive and non-Elected Governors is statutorily regulated.

UNISON argues that 20,000 members will not effectively represent the views of the entire population. Manchester, Greater Manchester and the entire North-west, which the CMMCUH serves, has a population of several million. Who are going to be those most disposed and most available to become “members”?

Middle-class, literate caucasians ...

Third gripe. As patients, clients or customers of the CMMCUH, and regularly and frequently visiting one of your hospitals for one year and a half, were we presented at any time with this consultation document ? Was it there to pick up in the corridor of the hospital ? Next to the copies of the local daily free newspaper Manchester Metro?

And the pathetic consultation questionnaire had to be submitted by 30 September.

However, it is not apparently too late for me to become a member.

Again, the government wants me to make Choices.

So, Dear Readers, should I or should I not become a member?