No NHS hospital is an island when it fails financially

No one actually wants to go out on the streets and wave a placard protesting against the closure of their local hospital. But against the backdrop of an often polarised NHS debate, it’s no surprise that protest has become synonymous with one of our most beloved public institutions.

The need for services to change has unfortunately, but quite understandably, become a political football, with patients stuck sitting on the subs bench.

‘It’s no surprise that protest has become synonymous with the NHS, one of our most beloved public institutions’

In recent weeks commentators on the left and right, including the secretary of state, have had their say about a particular clause in the Care Bill − a piece of legislation currently being scrutinised in the House of Commons.

Last week, the government published amendments to clause 118 to make it far more palatable on both sides of the political divide.

Administrators with sweeping powers

The NHS Confederation and a group of health organisations, including the Foundation Trust Network, have fought on behalf of patients and our members to secure changes to the bill made on Friday. We are pleased the government has taken our concerns on board.

But sadly the debate over clause 118 epitomises our collective failure to have an honest and transparent conversation about what the NHS is and what it needs to be in the future to meet patients’ needs.

‘Failure isn’t neat or tidy, it’s messy and quite often creates a ripple effect beyond the lines on a map’

There is concern that clause 118 will give trust special administrators sweeping powers to close local hospitals or units with little or no consultation.

The trust special administrator regime is put in place only when a trust finds itself at financial breaking point. Their role is to consider what changes could be made to ensure patient care is sustainable while avoiding the dire consequences of financial failure. Speed is of the essence when making these recommendations.

Messy business

Ask any one of our members and they’ll tell you that no NHS trust is an island. After all, the cause of failure in quality or finance can often be rooted in how the local health economy operates in its entirety, not just one hospital.

So when considering financial failure, we need to look at the whole local health service and not just one trust in isolation. Why? Because failure isn’t neat or tidy, it’s messy and quite often creates a ripple effect beyond the lines on a map.

‘When considering financial failure we need to look at the whole local health service and not just one trust in isolation’

This is why we’re pleased with the amendments published on Friday that require special administrators to conduct further, more extensive consultations with other affected areas.

Essentially the changes mean the scope of their consultation − in the event of a failing trust − will be matched by the scope of recommendations the special administrators might make.

Extending the scope of their influence must be coupled with an extension of the responsibilities on them to ensure changes fit with the wider community.

Clear strategy

But we cannot pay mere lip service to people’s views on their care. This means our members, local clinicians, the special administrators, politicians and everyone else involved in proposals to change care locally, need to strike up a dialogue with people before trusts reach crisis point in the first place.

‘Crisis driven change means a greater risk of compromise and potential for proposals to be rushed through and alienate local communities’

This is why the NHS Confederation and FTN are urgently calling for the Department of Health to set out a clear strategy for stopping trusts from going into administration in the first place.

This means making sure there is proactive regulation covering both finance and quality in place that spots potential failure long before it happens and puts in place effective support for those trusts.

When tackling failure, prevention is much better than struggling to find a cure − a point that I’m sure all politicians would agree with.

Political challenge

Crisis driven change means a greater risk of compromise and potential for proposals to be rushed through and alienate local communities.

NHS organisations are tackling rising demand for care at a time when there is a flat funding settlement. This means an increasing number of trusts teetering on the financial precipice.

As we head into the general election, our 2015 Challenge campaign is urging all politicians to be candid with the public about this financial challenge and set out how they would tackle it if elected.

Silence on this will only lead to more placards and more protests.

Matt Tee is chief operating officer at the NHS Confederation