Headlines: January 21st, 2003

The British Medical Association is warning today that Foundation Hospitals may increase inequalities in the National Health Service by widening the gap between the best performing hospitals and those struggling to improve services.In evidence it is submitting to the Health Select Committee, the BMA says the hospitals could recreate the disadvantages of the internal market inĀ  health care created by the NHS changes of the early 1990s.

The BMA says much greater priority should be given to helping under-performing hospitals to improve and that more freedom to innovate would help them to do so. These freedoms, though, are available only to three star and foundation hospitals. That, the Association says, increases the risk of creating a two-tier system.

Government policies, the BMA says today, may contradict one another. Foundation Trusts will have to demonstrate long-term guaranteed revenue streams in order to access borrowing, but this need for financial stability is at odds with the overarching plan to give individual patients more choice by ensuring that funding follows the patient.

And the evidence warns that setting up foundation trusts as independent decision-making bodies has implications for the coherence of the wider local health economy. “Primary care trusts have responsibility for determining local strategic priorities and the decision-making role of foundation trusts must be structured so as to support PCTs in this role. It is not clear how this will be achieved and there is a likelihood of foundation trusts deciding on and pursuing priorities which conflict with those of PCTs,” the BMA says.

It is also worried that poaching of staff from less favoured hospitals will be a real concern as it could trap hospitals in a spiral of decline. “The flexibilities offered to Foundation Hospitals are likely to leave other trusts with worsening recruitment difficulties, especially in recruiting the most experienced and most sought-after staff, an effect which will be particularly marked on neighbouring trusts,” it says.

The BMA is also unhappy about reported plans to give Foundation Hospitals total freedom over pay and conditions for staff. As well as its fears over recruitment it says local bargaining is inefficient, time consuming and works against the concept of a truly national health service.