Why journalists should be worried about the NHS reforms

Imagine there was a hospital trust in your area which employed 10,000 people – one of the top five employers in an area. It has a turnover of £265million, operated 1,200 beds across several large hospitals and was relied upon by over a million people in times of need.

Imagine, as a journalist, if you were told you couldn’t receive their monthly board meeting papers, and were told that the meetings themselves were being held in private. Why? Because the hospital trust in question has Foundation trust status.

The hospital trust I’m referring to above is Heartlands, which serves a large part of the West Midlands. It does publish minutes of the meetings online but hasn’t published an agenda ahead of the meeting since the turn of the year. Its website confirms that its monthly board meeting is held in private:

“The hospital management is led by the Board of Directors. They are responsible for all operational and strategic issues, business and finance and they meet once a month in private.”

Instead, it has a ‘Governors’ Consultative Council’ which meets several times a year and can hold the board to account. They represent some 100,000 people who signed up to be ‘members’ of the Trust when it became a Foundation Trust. These meetings are in public, but in terms of reporting on the board meetings where decisions are made on a monthly basis – forget it.

When Labour introduced the Foundation Trust status, the appeal for hospitals was that it brought extra freedoms. One of those freedoms was that it removed the requirement for board meetings to be held in public. There are around 100 hospital trusts with Foundation status, and according to evidence presented to a Parliamentary health committee in 2009, around two-thirds hold their board meetings in private.

Among the Foundation trusts which met in private was Mid-Staffordshire, the scandal-hit hospital trust where a government investigation found that patients were routinely neglected, humiliated and in pain as the trust focused on cutting costs and hitting government targets.  Minutes from the same health committee noted:

At Mid-Staffordshire Trust, the Board conducted a lot of its business in private before it became a Foundation Trust and thereafter held all of its meetings in private. They have since begun to hold them in public again.

It’s a situation the Royal College of Nursing has expressed concerns about. I blog about this today because prime minister David Cameron has been talking about his NHS reforms, and placing a real emphasis on accountability. Within his speech was the following reference:

The whole point of our changes, the whole reason why transparency and choice are so important, is so that patients can hold the health service to account and get the care they demand, where they want, when they want.

The problem here for journalists is two-fold. First of all, the Government has repeatedly said it wants to create more Foundation Trusts – therefore in theory creating a situation where even more hospital trusts could dispense with the need to hold their decision-making board meetings in public. Such a move promote neither accountability or transparency ahead of decisions being made.

The second problem is the decision to scrap primary care trusts in favour of GP consortia doing the commissioning. At the moment, PCT board meetings are open to the press to attend. Vitally important decisions can be made at these meetings, yet there is no guarantee that the consortia they are being replaced with will be obliged to meet in public.

Liberal Democrat peers have picked up on this and are campaigning for consortia to be obliged to meet in public, while many health charities and organisations are also concerned about this too.

Talk of consortia and Foundation Hospital trusts being accountable very an over-arching body, called Monitor, won’t solve this lack of transparency. Strategic Health Authorities (due to be scrapped) are supposed to hold hospitals and PCTs to account – but as I’ve mentioned before, they often make covering health issues more difficult. Monitor already, er, monitors Foundation trusts, but it isn’t interest in the month-to-month decisions which journalists, and our readers, are.

Ironically, one of the biggest challenges the government faces is explaining to a bemused public what all the fuss is about with its changes. Perhaps if it wasn’t so hard to understand how decisions were made by the NHS, more people would get it. Ensuring journalists can cover the decision-making openly is fundamental to that.

For journalists, there’s a very real danger that it could become harder than ever to report on how decisions are being made in the NHS – and that’s something we need to shout about.

 

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13 comments

  1. Excellent overview David and an issue the public are totally ignorant about. I intend to flag this up to my MP Tim Farron. Keep on campaigning it’s what journalism is all about.

    1. Thanks Sandy. Tim Farron was an excellent councillor I used to work with on my first paper – he was brilliant then, hopefully he will be now!

    1. If I thought you were serious – oh go on then, here’s a serious response.
      1. This information should be in the public domain anyway.
      2. FOI requests can’t compare from being able to attend meetings and monitor debate during meetings
      3. It’s more expensive for authorities to deal with FOIs than to be open.

  2. An excellent blog but it’s not just Foundation Trusts we should be worried about. There is also no requirement on the new GP consortia (or whatever they will be called after the current listening exercise) to hold their meetings in public and my understanding is that most are planning to hold them in private too. Given that they wiull be responsible for spending hundreds of millions of punds on servcies that affect the entire population it is even mopre important that they are open and accounatble in their decision making. Yet an article in the Health Service Journal recently on the exclusion of even practice nurses and mnanagers from most consortia boards (never mind hospital doctors) failed to even mention this issue. My experience of working in the NHS is that most clinicians and managers will be only to happy to exclude even this minimal scrutiny of their decision making.

  3. A similar issues was looked in detail by the Radio 4 programme Analysis last year. For example

    No consultation at Gloucester hospitals were hundredse of beds were being ‘de commissioned’. This was only uncovered by the relative of a patient who was told that the patient would have to go to another hospital and was told that no beds were available at Gloucester- there were but had been mothballed- she got her relative a bed . This information about there being no beds was first told to her by her GP ! So decisions such as this were taken in secret by Gloucester Foundation Trust.

    When asked about this Monitor’s David Bennet [Deputy ?] Director came out with the usual managerialist Orwellian/Birt like double speak of cliched garbage

    “Different trusts have different ways of providing transparency.Issues of COMMERCIAL SENSITIVITY [of course] which simply [sic] means we cannot be dealt with in a public meeting. It is challenging to provide enough transparency to meet the needs of the local community, so holding part in private is necessary”.

    In Warrington hospital the management team tried to make some meetings secret to take part in ‘lateral thinking’ [ this is true].

  4. As a large employer and a significant deliverer of healthcare across the region we are very keen to be both open and transparent. We have recently been reviewing the opportunity to return to having public board meetings and this is something we are considering along with additional Governors meetings all of which are already open to the public. We hold member seminars on a monthly basis to which anyone can attend and we are working with the Governors who are publicly elected to improve the information flow and understanding not just within our Governing Body but also with our 100,000 members and the public.

    We are very keen to make available as much information about the organisation as possible and have recently started to publish all of the freedom of information requests we receive. We will also from next month be publishing ward by ward patient experience date which looks at what our patients are saying about the care they receive in hospital. This is already displayed on each ward for the public and patients to see. The next information which will be published is our nursing matrix data which shows ward by ward the standards of care set against important issues like pressure sores and falls. As the new Chairman of the Trust and supported by our new chief executive I appreciate we have a long way to go, but we are more than willing to share information.

    We have a long track record of working with the media and are keen to invite them in to ask questions and see for themselves the work we are doing. This includes a project which we hope will be taken-up by the BBC looking at care of the frail elderly in hospital. I, along with the Board, am committed to patient safety and quality and fully appreciated the need to share information to show how we are tackling some of the most challenging changes to the NHS whilst continuing to drive up standards for our patients.

    Thank you for raising this issue – I will be sharing this with the Board.

  5. Last year I attended a Heartlands event which pretty much sums up the role of governors:

    “In a Q&A at Heartlands Hospital, Bordesley Green, the seven governors present were asked to rate their influence on the board on a scale of one to ten, worst to best.

    “Ms Sproston rated her influence as a three while the others present voted a ‘two or three’, six, five, ‘five or six’, six and ‘five to seven’. There are 44 governors”

    http://thesilhillian.blogspot.com/2010/03/solihull-maternity-on-borrowed-time.html.

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