Hospital trusts... who makes the decisions?

"THE NHS of the future will be one of patient power; patients engaged and taking greater control over their own health and their healthcare too." This was said by prime minister Gordon Brown, as reported in the guardian on 7 January 2008.

Hugh Caffrey, Manchester Socialist Party

However, only last summer, I read in the Manchester Evening News: "Health bosses at Wythenshawe Hospital have voted to stop holding monthly board meetings in public, in order to protect commercial information".

So what does Brown's "patient power" mean in practise? While his cronies take hospital management further out of the public eye, he is going to abolish the 'public-patient involvement forums' (PPFIs) that patients currently exercise limited 'power' through.

This year, all National Health Service trusts will become Foundation trusts, moving further from the remnants of democratic control and closer towards the private sector. As the Manchester Evening News noted: "NHS hospitals are required to hold open meetings unless discussing sensitive information. But Wythenshawe has more freedom because it is a Foundation Trust".

Other Foundation trusts have done the same. They are driven by profit, with "growing numbers setting up joint ventures, special purpose vehicles and charities to get around a legislative cap on the amount of money they can earn from private patients" (Financial Times 1/2/08).

New Labour tries to hide privatisation behind their version of democracy. Trusts have 'members' - staff and others, who elect a minimum of 51% of hospital 'governors', including one staff representative. Almost anyone can be a member, but the governors cannot be held accountable. And staff are banned from the board of directors, which actually makes the decisions.

With up to 49% of governors being appointed by NHS bosses, local politicians, and 'partner organisations', such committees are easily stacked in favour of the trust.

To ensure no-one steps out of the pro-privatisation line, the trust regulator can fire governors and directors, and appoint more directors. One study summed this up as: "a transfer of ownership and control from the Secretary of State to independent corporations... the claim about local control is not supported by the arrangements... NHS consultative and complaints machinery is waived for Foundation Trusts" (Pollock & Price, In Place of Bevan?, 2003).

The government engineered a reorganisation of the NHS in 2003 to push many hospitals towards privatisation and ensure those in charge could do so without obstruction. Soon, all 400 public-patient involvement forums will be abolished.

The replacement 'local involvement networks' (LINks) will have less funding, channelled via local authorities, and their 'hosts' could be any of a number of voluntary-sector bodies.

Anti-cuts campaigner Judie Collins, member of Trafford PPIF, said in a personal capacity: "The abolishing of PPI forums is a nightmare. The trusts aren't actually forming a farewell committee to wave us off but it's a close run thing. I think hardly any councils are prepared for LINks. Meanwhile Trafford health trust are closing wards and flogging them off to other trusts to lessen the debt. Staff are having aspirational interviews and we all know what that means!"

Privatised NHS

The Tories and New Labour have consistently eroded any means of democratic control over the direction of our NHS. Community health councils had to be consulted by NHS bodies over major changes, and if they disagreed, could refer them to the government. Community health councils were abolished. PPIFs were introduced to cut across opposition - but they didn't, so now they too are being scrapped.

Under New Labour's agenda, private health companies are certain to gain. The miserable 'choice' increasingly offered to us is a privatised NHS, profitably absorbed by the private sector, or a privatised NHS bankrupted by the private sector. The bosses' newspaper, the Financial Times, actually debated (15.11.07) which would be best!

What is to be done? Workers need to reclaim their unions, especially Unison. Nationally, left candidates, including Socialist Party members, are standing for the Unison health service group executive.

Legal challenges and tribunals are no substitute for a national campaign. At workplace level, a stronger solidarity network between groups of health workers can prepare a serious struggle.

The NHS was won in the first place by tremendous pressure from working-class people.

Now it can only be saved in the same way it was won. Starting with the vital community campaigns and the 250,000+ people who have participated in local demonstrations, linking up with health workers and others, a united movement can be built.

Elected in Kidderminster, Huddersfield and elsewhere, anti-cuts campaigns have shown we can defeat the representatives of the pro-cuts parties.

This May's council and assembly elections should see the widest possible expansion of this. Winning local elections can significantly boost local campaigns. More broadly, workers and campaigners need a mass new party, a platform for organising and fighting.

The NHS can only be rebuilt as a public service; the capitalist market cannot organise health care for all. Private health companies like BUPA and the pharmeceutical multinationals should be nationalised and integrated into a socialist plan for health care.

Waste and bureaucracy can be combated through democratic control by elected representatives of staff, patients and the wider community both locally and nationally.

Huge resources exist, enough to provide a high class health service for everyone. But a small number of millionaires, shareholders and rotten politicians stand in the way. They haven't yet killed the NHS. But with every cut, the need for a unified national movement and a socialist alternative becomes more urgent. Join us to fight for it!

Why not click here to join the Socialist Party, or click here to donate to the Socialist Party.

In The Socialist 12 March 2008:

Demonstrate