What are foundation hospitals? If the Labour Party and their Government are to be believed the reform programme which includes foundation hospitals “…is every bit as radical and progressive as that which created the NHS over fifty years ago. It draws on the traditions of social and community ownership that inspired the founders of the NHS. It sticks firmly to the principles on which the NHS was founded. And it places a premium on local accountability for local services.”* Meanwhile back here in the real world foundation hospitals are recognised by many as the further step to the destruction of the NHS that they really are.
When, in 1991, the internal markets were introduced to the NHS and ‘trusts’ were set up as semi-autonomous business units to run local NHS care provision, they were required by law to, at least, break even financially, although their ability to borrow from the private sector or keep the proceeds of land sales etc., was restricted. Also the trust was the sole care provider in its hospital. The internal market saw bed, ward and whole hospital closures (with the obvious job and care losses associated with such actions) as managers closed parts deemed to be ‘non-profitable’ in their rush to balance the books. Trusts merged with other trusts and more ward and hospital closures followed as the now enlarged trusts did away with ‘duplication’ of services. This often meant the need for building a new hospital in a central position within the enlarged trust’s area (closing or radically downgrading other hospitals in said area).
In 1992 the Private Finance Initiative (PFI) was brought in to raise funds privately for new buildings which would remain privately owned but rented to the trusts, meaning in essence that the NHS would pay far more for a new hospital than if they built it themselves but would never own either the hospital or the land it was built on. PFI, according to UNISON, “drain hospital revenue budgets, leaving less for direct patient care – the high costs of the first wave PFI hospital schemes resulted in a 30% reduction in beds and a 25% reduction in budgets for clinical staff.”**
This then was the situation up until the Foundation trust/hospital scheme. The most significant change under the foundation scheme is that on top of the existing ‘internal market’ that every trust and hospital had to operate, hospitals and trusts must now be in direct competition (external market) with each other for funding and patients/customers. This will surely see the arrival of a few ‘super’ hospitals across the country. The other significant change is that the trust will no longer be the sole care provider in the hospital as the doors are thrown open wide to private companies to become care providers inside the NHS (quasi-NHS would be a better term) hospital. At present foundation hospitals (and any private company operating within them) will not be allowed to charge patients for any medical treatment but they will be able to sell medical insurance, negotiate private funding/loans, charge for non-medical extras, and sell land and keep all the profit within the trust instead of it going back into the NHS to be distributed to where it is most needed. In the short term the sale of usually well placed land will be very lucrative and will enable the foundation trust/hospital to pay more to its staff because the foundation trust/hospital will also be allowed to negotiate wages and conditions with its own staff killing off national pay structures for health workers and seriously endangering any chances of unified industrial action. This will help create a two tier NHS as non foundation hospitals lose staff, funding and patients to the foundation hospitals that can, initially, pay staff more, meet government targets easier (they are to have far less rigorous monitoring) and be able to advertise their wares. Of course the hospitals that can’t make it to foundation status will sink lower and lower in the governments league tables until they hit the point (zero star) where private companies can bid to manage them.
The foundation trust/hospital is only a part of a ten year health plan put forward by this Labour Government. This must be challenged and fought against but this cannot be done by looking at hospitals, or even the whole NHS, in isolation without taking into account the political system which we live in. The NHS, and indeed, the whole welfare state, has been maintained, on top of the exploitation of the working class at home, by the super-exploitation of the workers of foreign origin in this country, as well as the super-exploitation of the peoples of the vast continents of Asia, Africa and Latin America, in addition to the looting of their mineral wealth. However, the imperialist crisis of over-production is forcing each imperialist ruling class to cut spending in order to be able to win in cut-throat competition of the world market. Hence the attacks on the NHS, education, pensions, unemployment benefits and every other social provision which the working class in the imperialist countries has come to regard as God-given since the Second World War. Nothing, however, under the conditions of capitalism, is forever. Benefits gained by the working class during happier economic conditions, or as a result of the peculiarities of the world balance of forces, can easily be whittled away as the circumstances giving rise to these gains disappear.
This gives us the choice of siding with our own imperialists (in the hope that they will kindly restore the NHS and other parts of the welfare state to what they were) and supporting the oppression of foreign workers and struggling states right up to, and including, a full blown third world war as the imperialist states are left with no option but to fly at each others throats to defend or increase their own profits, or we can stand up to our own imperialists (which means standing with and supporting those foreign workers, as well as the vast layers of destitute and disadvantaged workers here) and overthrow them to create a socialist state that exploits neither its own nor foreign workers. This is the only real choice facing us, organisations which do not address this choice are guilty of deceiving the workers in this country.
UNISON, the union who have placed themselves at the front of opposition to foundation hospitals, have this advice for those wishing to campaign against foundation hospitals – “Write to your MP and to Alan Milburn, the Secretary of State for Health, saying why foundation trusts are bad for the NHS. Get your local council to use its scrutiny powers to challenge the potential impact of foundation status on the local health economy. Get your local Constituency Labour Party to take up the issue.”*** Surely even UNISON realises that it is the Labour Party, with the support of all other bourgeois parties, which is introducing the foundation system? It must also be obvious that these parties are all very well aware of what will result from their schemes but they are supporters of imperialism and defence of bourgeois profits comes before everything else, this is the nature of imperialism. One has to wonder if UNISON’s position at the head of this campaign is to lead or to hold the campaign back? Both activities are performed from the same position. There can, however, be no real fight-back until trade unions and political parties that consider themselves socialist understand and set about explaining to workers three things.
1. The nature and workings of imperialism. 2. The need for theory to direct practice. 3. That the only tried and proven theory that brings about the proletarian dictatorship, and therefore socialism, is Marxism-Leninism.
* Department of Health. Introduction to NHS Foundation Trusts.
** Foundation Hospitals and the NHS Plan published by UNISON February 2003.
*** UNISON website, Keep the NHS public – Foundation Hospitals.