Panicky response to Mid Staffs scandal could erode FT freedoms

The danger comes in a Department of Health consultation paper on mechanisms for de-authorising FTs.

The principle behind the paper, published in the wake of the Mid Staffordshire scandal, is fair: if a foundation trust fails to maintain standards it can forfeit its privileges.

The problem comes in the plan to give the health secretary the power to request Monitor to review the status of a foundation trust, including pushing for de-authorisation.

The DH consultation paper talks of intervening in exceptional circumstances, such as where a significant failure has occurred or where there has been a loss of public confidence.

This has the hallmarks of a panicky response to a public relations disaster for the NHS. The Care Quality Commission has a formidable armoury of powers to deal with service failures, while foundation trust regulator Monitor already has the power to sack directors and boards. The Health Bill includes a six month de-authorisation process.

The consultation paper says the public might ask the secretary of state to get involved. In plain English this means giving the health secretary the power to cave in to media hysteria.

The time proposed for Monitor to respond to a “request” from the health secretary gives the game away - just one week. That is a timescale dictated by the desire to respond to newspaper headlines rather than calmly, objectively assess the facts.

If Monitor refuses to do the health secretary’s bidding the consultation paper sets out a schema for what would amount to a media war between regulator and minister. The dispute would quickly become a struggle for power as two big beasts of the health world locked horns. The true interests of patients would be sidelined.

Foundation trusts were intended as a decisive break from central control. Regulators and boards, not ministers, were supposed to be accountable for their performance. This plan would weaken that ideal.

This is a badly drafted consultation paper putting forward a power for politicians which is too wide and poorly defined. It would allow the health secretary to pull political stunts at the behest of the tabloids which undermine the independence of foundation trusts and the regulator, saddle ministers with the burden of intervention and do nothing for the interests of patients. No one is objecting to the health secretary offering his view but the delicate balance between independent foundations and a national health service requires more subtle drafting than this.

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