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.