Examination of Witnesses (Questions 240-259)
TUESDAY 11 FEBRUARY 2003
MR DOUGLAS
PATTISSON, MS
KAREN BELL,
MR MALCOLM
STAMP AND
MR CHRIS
BANKS
Mr Burns
240. Do you think that foundation hospitals
would have the power with senior managers if they screw up badly
to actually sack them? Given what you do for a living you will
be acutely aware that anybody who fouls up at your level in the
NHS gets shunted to another position in another trust area on
the same salary and pension rights. Whatever you do there is no
way of getting rid of you and severing your connection in the
Health Service. Do you think you would see more of that? (Mr
Stamp) I think the Board of Governors can do it and also the
proposed regulator, from what the guidance says, can also do it.
I think it would appear there is no problem in getting rid of
managers.
241. Do you think the culture will do it? In
most other areas in the country if you muck up spectacularly or
you do not perform properly you pay the ultimate price. The Health
Service seems immune to that sort of procedure. (Mr Stamp)
I do not think the Health Service is immune from that procedure.
242. Have you come across anybody who has been
sacked and left the Health Service? (Mr Stamp) I have
come across people that have been sacked. I do not think it is
true to suggest that being moved side ways does not happen in
other large organisations, because it does, Shell BP, ICI, we
can go on and on with the names. It is not true to suggest that
you get sacked if you foul up somewhere else, that is not the
case.
243. Is it a reasonable thing in modern day
NHS for people to be sacked and leave the NHS? (Mr Stamp)
Yes.
Mr Burns: Really!
John Austin
244. We do not know yet whether the argument
between Alan Milburn and Gordon Brown will settle but one of the
attractions of becoming a foundation trust is the financial freedom
that will be available to it. We had a very good example in evidence
last week from a two star trust of a very innovative scheme that
they brought in and it was highly successful,despite all of the
odds, and it was at two star trust. It is not really a question
for Mr Pattison, it is a question for the others, if there is
an ability of one star, two star or no star trust to be in a position
is there any reason to deny Mr Patterson the right to become a
foundation hospital and have these freedoms too? (Ms Bell)
I was just saying earlier that I think that if I was going to
develop a new model of management in the NHS and introduce it
gradually and pilot it to see if it would work I suspect that
I would start with the higher performance organisations because
the risk would be less and the potential earning more. I would
be in favour of let us suck it and see and no doubt, as with NHS
trusts, it will be rolled out, I think that is the policy intention,
across the rest of the providers in the NHS. I think that is a
good place to start. (Mr Stamp) I would agree with
Karen. As I said earlier the level of entry for the first wave,
because it seems this is now the direction nationally, that all
trusts will ultimately become a foundation trust, should start
with ones being recognised as the high performing trusts and whatever
follows after that follows. I think that is a reasonable opportunity.
I think Douglas would be the first to admit that he has had to
undertake a great deal of work and I think we are all confident
that we will see Hinchingbrooke climb the star ladder anyway.
Dr Naysmith
245. We were talking a few moments ago about
being able to pay some staff a little bit more than others, we
are not very clear but you do not think that will happen very
much in the NHS anyway? Also, in the proposals there are restrictions
on the amount of private patient income you are going to have,
restrictions on borrowing and restrictions on disposable assets,
how much scope do you actually think there will be with all of
these restrictions? How much scope will there be for entrepreneurialism?
Do you think there will be room for the kind of competition some
people are suggesting ought to be there? (Mr Stamp)
I can understand the reasons why there is the restriction on the
assets, I think that lock-in is an important message if we are
serious about getting local ownership through the board of governors.
We accept what was said about private patients in the guidance
but I am less clear why that has been particularly picked on in
the sense that the operating licence could quite strictly control
through the Regulator the private patient income was not to the
detriment of NHS care within the licence but for the NHS to give
up the prospect of private patient incomes to the level available
in the open market I am not too sure is wise. In terms of the
other innovations that are available I think that one of the answers
about lock-in of the local community to the board of governors
it is so that we can in simple terms spread our interests and
knowledge and learning to wider corners of the communities we
serve. We are very good with our vertical hierarchies and our
non-executive directors who do bring different skills and knowledge
and we do have links with patient forums through community health
care, and so on, but here we have buy-in from the local community.
We employ 6,000 people, we are a major economic force.
246. Are you suggesting that you would like
more freedoms than are contained? (Mr Stamp) There
are a lot of opportunities where we can support local community
initiatives round training.
247. You would like the freedom to do that? (Mr
Stamp) Yes, we would.
248. Last week we had a very interesting series
of answers from the chairmen of two or three trusts, a couple
of them said they would go for it if there was no increase in
income. One of them, a London teaching hospital, said very honestly,
give us the money that is all that we are interested in. Would
you be on that side? (Mr Stamp) No. If there was the
non-regulated side, as it is described, we would be still be interested
in it. What I am saying is, answering the earlier points, the
expansion of income and the controls round that I can understand.
The lock-in round assets, I am less clear about and probably philosophical
about private patients because that is money that we can direct
into the National Health Service, that must be good money given
and we do it everyday anyway providing it is not at the detriment
of NHS care, and the Regulator should be able to take care of
that. The other side of the equation where you can generate income
I think is by taking this wider, social integrated role that the
new board of governors offers up without buy-in from the local
communities, and that is something that we have to learn in terms
of our external management for the future.
Julia Drown
249. Limiting your private patient income at
this year's level basically will restrict what you might be able
to do for NHS patients in the future? (Mr Stamp) I
said the opportunity is there, we do not do it a great deal to
be honest. We had no plans to expand it before this rule so please
take it from the spirit that it is being said, it is not about
we want to do lots and lots of private patients, that is not where
we are coming from. What I am saying is this is our stock in trade,
this is what we do every day and to put a cap on that as an income
opportunity for the NHS, providing the Regulator was strictly
controlling it was not to the detriment of the NHS care, feels
a bit like philosophical overdrive.
250. Can I move on to general freedoms, we know
that foundation trusts are still going to be subject to national
data collection systems and CHAI inspections as well as your own
two year licensing reviews, from your point of view how much do
you think the bureaucratic burden really is going to be eased
on foundation trusts, what is your understanding of what these
extra freedoms are? We know about the financial freedoms, we discussed
those, Karen Bell you wrote in your evidence about the freedoms
that could help foundation trusts, what do you think these extra
freedoms are? Do you think they are a bureaucratic burden and
will be eased? (Mr Stamp) We believe it because it
is promised in the guide.
251. There is nothing specific, you do not need
to have patient forums. (Mr Stamp) The bureaucratic
burden that we talk about is the level of separate regulations
that we have. I think that the independent regulator and CHAI
are two very powerful external regulators to any NHS establishment.
252. Who do you think is not going to be regulating
it? (Mr Stamp) I am not sure. I hope there would be
a different performance management approach. Hopefully we could
have less national targets but keep ones that are applicable to
the whole of the NHS. I would like to see more locally driven
targets to engage what I was talking about before, if we are going
to get buy-in at a board of governors level it would be good to
have relevant targets emanating from that engagement rather than
just follow the national targets.
253. Do you think it would be right if you might
have less national targets, even though I have not heard anything,
if you had your way on that, had less national targets, would
it be right that you had less national targets that your next
door trust? (Mr Stamp) No. I think there has to be
a standard core. I think there is general acceptance that there
is probably too many now anyway. I notice there is an article
by the new chairman of CHAI on the Secretary of State's dimension,
the problem with too many targets. What I am getting at is there
should be a hard core of national targets that are applicable
to every NHS establishment, everyone accepts that and that links
to the discussion, as we already said, about star rating. Other
than that there are certain things that feed the measures of those,
beyond that it would be nice to have some expectation that there
are locally driven targets as well to embellish that local input.
Andy Burnham
254. I just want to talk about the membership,
the government structures and the idea of a cooperative society,
a mutual society where people can opt to become a member and therefore
have a stake and control in the organisation. Bradford Hospital's
NHS Trust told us last week that out of a local population of
400,000 and 4,000 staff they would expect roughly 10,000 people
to opt in to become members of the Bradford Hospital's Society
or whatever the organisation is that may emerge from the foundation
application. Could I just ask, I know you all represent very different
kinds of trusts and serve different communities, would you be
prepared to put a figure on how many people you might think would
opt in to join your trust? If you were able to do that do you
have concerns that that might be predominantly one section of
the community rather than a broad sweep of local opinion? (Mr
Stamp) I can say that we have not done any calculations or
guesses on that at all I cannot answer that question. (Mr
Banks) We have no sense of what the sign up would be. The
issue of whether you are getting it across the community is an
interesting one, that is something that if we take it out we have
to make sure we are covering that area.
255. Yes. Generally on the point about a self-selecting
constituency, do you have concerns about that? I am thinking about
Cambridge, you might get a very transient population with students
and you might have a strange, odd constituency and also being
a teaching hospital you would have a wide range of groups, would
you have concerns about managing those interests? (Mr Stamp)
No, I think we would do it in the spirit of the guidance we receive
and we would try and make sure that we use your proper postal
reference so that, picking up your point about what has already
been mentioned, we can make sure there is some spread. We have
to be mindful of that, you are quite right.
256. Do you believe, like I do, there has been
a democratic deficit in the NHS, that it has not been good at
listening to and responding to local opinion. (Ms Bell)
I do believe that, not only do I believe that but I know that
colleagues in the rest of the public sector, local authorities,
often quote that and now that we are working as strategic partnerships
it is mentioned more frequently. I think that over time to have
an increase in local representation can only be helpful. Certainly
what we are getting much better at because of these partnerships
is listening to local representatives who are elected and they
are having greater influence through scrutiny on what we are doing.
257. I have heard some scepticism in certain
quarters, people saying it is a token gesture, do you think—for
a second let us suggest that it is not a very real exercise in
democracy—some of your colleagues, not only in your organisation
but across the NHS generally, are ready to open up the doors and
let the great and the washed in and let them have a view on how
health care should be delivered. They may come up with different
priorities than the people who run the Health Service generally. (Ms
Bell) I think it is difficult to engage with the public, as
I said earlier. We are all being encouraged to include local people,
users and carers in influencing the commissioning of services
and services development generally, people are expected to do
that and they are expected to do that in a way that feels inclusive
so you are not just getting middle-class people in Cambridge but
you are including ethnic minorities. We are working very hard
at that and will continue to do so. Frankly that has significant
influence over people's experience of services perhaps in a way
that is more real than representation on trust boards. It would
be good to see it there.
258. Do you think there really needs to be a
culture shift in the NHS to deal these new accountabilities? (Ms
Bell) I am saying that it is already happening.
259. It might be at your level. (Ms Bell)
I cannot speak for colleagues.
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