By paul corrigan
OVER the autumn there will be a growing coalition arguing in favour of radical change in the formation of NHS hospitals. Within the past two weeks the Royal Colleges of Physicians (RCP) and of Obstetrics and Gynaecologists (RCOG) have argued that the present composition of NHS hospitals leads to a lottery of public safety.
For the lifetime of the NHS, the public has been led to believe that every hospital can provide us with every service all of the time. Yet improvements in modern medicine have made that an impossible promise.
Greater specialisation in medicine can now save lives that would previously have been lost.
But it is not possible to have all these new specialisms provided everywhere all of the time.
There are also strong financial pressures that are making a number of hospitals unsustainable.
In June 2012, the Department of Health stated that 21 NHS hospitals that are “clinically and financially unsustainable” and need of restructuring.
South London Healthcare NHS trust is one of these. It has had the financial administrator sent in who will report to the health secretary next month.
A number of other hospitals from this list including Barnet and Chase Farm, Bedford, Epsom and St Helier are seeking partnership with other hospitals to try and become foundation trusts. Earlier this year a survey reported that 75 percent of NHS hospital trusts were discussing mergers.
But, as I argue in a report today by thinktank Reform, mergers offer insufficient change. A hospital that is clinically and financially unsustainable needs much more fundamental change to help it become sustainable. Success will depend on its ability to attract either strong NHS foundation trusts or private sector organisations to take it over.
Within the United Kingdom, however, we do not have as much existing private as public experience in running whole hospitals. This year, Circle became only the first private company to take over the management of a NHS hospital, the failing Hinchingbrooke in Cambridgeshire.
For example, the full range of hospital emergency services have traditionally been run by public-led organisations. Therefore I would expect most of these takeovers to be run by public sector foundation trusts.
However, only ideological rather than real reasons would exclude the private sector from this process.
Why would these takeovers succeed where the existing management has failed?
First, they have the capacity to bring about radical change within the hospital.
In the past few years successful hospitals have only thrived through radically changing how they deliver services. This needs strong clinical leadership to work with clinical staff to change the way they deliver care.
Successful hospitals have the medical leadership to do this. Unsuccessful hospitals do not
Second, a successful takeover needs the failing hospital to recognise and agree that it has very serious problems that need fundamental solutions.
This recognition provides the acquiring organisation with a strong case for change that previous managers of the failing hospital did not have. Failing schools have only been turned around when the staff and community have recognised and agreed that they are failing.
Success will depend on the ability to attract strong NHS foundation trusts and the private sector to engage in the takeover.
A major incentive must involve recognition by everyone involved that there needs to be major change and restructured services. No one will take over a failing institution if they are told to keep it exactly the same.
They need a licence to change.
At the moment unsustainable hospitals can only pay their staff because they receive a public subsidy. South London Healthcare trust receives £1m a week in subsidy.
Some of this price of failure could go into subsidising success. Offering half of that sum for three years might persuade a private company or an NHS foundation trust to take it over. If the takeover does not go ahead the government will go on paying this entire subsidy for ever.
Of course there is resistance to change in the NHS.
But the failure to challenge this with far-reaching transformation of hospitals is both dangerous and financially unsustainable.
The Guardian
