The Primer: Back to the foundations

Those who remember the unseemly scramble to create foundation trusts out of plain old NHS trusts might have smiled at The Times’ story last week on “academy-style hospitals”.

The health secretary is apparently planning a “revolution” that will allow “well-run hospitals more freedom”.

But freedom from what, from a fixed-income block contract? Freedom from NHS England to control your own communications? Perhaps freedom to not designate a refurbished wing as one of the 40 new “hospitals”?

When FTs were introduced the system was cash-rich and the powers FTs were granted over retaining surpluses were a bit more meaningful (even if they did sometimes mean the Department of Health’s capital budget ended up overspent).

But for every Frimley Park that did well out of that system, there was a Heatherwood and Wexham Park next door that had, for no good reason, facilities that were sometimes “third world” by comparison (quote from Andrew Morris, former chief executive of the former and then both).

Will we get an “Academy Trust pipeline” like we did for FTs? The resurrection of the NHS Trust Development Authority to once again fail to squeeze humble trusts through to FT status? Perhaps trusts that never achieved FT status will be able to skip it and go straight to AT status?

Many trusts only made FT with elaborate financial chicanery (to put it politely) or straight-up commercial loans from banks so they would suddenly appear to have liquidity.

And this was just the lighter side of creating FTs.

The darker side saw Liverpool Community Health Trust and Mid Staffs materially damage patient care in the quest to gain FT status (usually by just cutting the number of nurses). There were certainly others the public never heard the names of.

This is before you get to the fact that it would appear to reverse the policy tide of the Stevens era of greater integration and co-operation.

What will be different about these unfortunate organisations as they seek to treat the monster backlogs?

Tense discussions

Talking of the elective waiting list (now over 6 million people, more than 10 per cent of England’s population) The Guardian reported on Friday “tense” discussions between the Treasury and the NHS on whether to “really crack on” or “keep it real” and acknowledge the Omicron pressure.

This seems a little quaint considering a) the unaddressed consultants’ pension crisis might soon make a lot of this moot and b) it’s not like the NHS doesn’t have experience of missing unrealistic targets over prolonged periods.

Solving the pensions issue would cost something and the government also faces pressure from articles like this one in CapX arguing that NHS funding has gone from “safety net to straitjacket” for the rest of government, and that there is a “cost of putting ‘health’ above care in our NHS”.

Staff vaccination latest

Several news reports emerged last week about a potential delay to the deadline for patient-facing staff to get their covid-19 vaccinations.

The latest briefing, given to the Sunday Telegraph, quoted a Whitehall source saying the requirement would likely be “kicked down the road” following pressure on Boris Johnson by Tory backbenchers.

Apparently, the plan is to push the deadline back by six months – ostensibly to give staff a chance to get their booster jabs too, which is acknowledged to be far more effective against Omicron than two doses.

However, speaking to the BBC on Sunday morning, deputy prime minister Dominic Raab appeared to stand by the current plan for mandatory vaccination.

If a delay is not forthcoming and thousands of NHS staff are sacked or quit, then some may look westwards for new employment.

Speaking to the BBC yesterday, Welsh first minister Mark Drakeford said he would “not rule out” recruiting NHS workers from England who leave for jab-related reasons.

Vaccinations are not compulsory for NHS staff in Wales, and Mr Drakeford said there were no plans to change this.

Mr Drakeford said: “I don’t expect us to go looking for people who have not been vaccinated but, if people apply, then they would be interviewed in the normal way.

He added: “We wouldn’t rule them out, but we certainly won’t be going out there looking for them.”