22/3/02

You may have received correspondence from UNISON recently about our plans for reform in the NHS. I thought it might be helpful for you to know the actual position as distinct from that set out in the UNISON campaign.

First and foremost we are not either privatising or breaking up the NHS. The NHS Plan we published in July 2000 – which UNISON supports – sets out a ten year programme of investment and reform to improve services for NHS patients. Central to this reform programme is the recognition that performance across the NHS is simply too variable. There are a good many local services but many that are not. The problem is that successive governments have treated the NHS as if performance was the same everywhere. The NHS Plan said that in future where services were doing well they would get more freedoms and more rewards. In other words there would be a positive incentive to improve. Where services were not performing well, there would be help, support, and where necessary, intervention. It is actioning this NHS Plan reform that UNISON seem to find objectionable.

The current position is that the Department of Health is discussing with the best performing hospitals the range of freedoms they could have, in particular from day to day management interference from the Department of Health. No final decisions have yet been made but one of those proposals, being examined is for Foundation Hospitals. These could be based on the co-operative or mutual principle allowing greater staff and public involvement in their running than at present. The hospital, of course, would remain part of the NHS. It would not be private. It would be subject to national NHS standards and NHS inspection through the Commission for Health Improvement. It would, as now, be an NHS hospital.

Nor – as UNISON know – would these developments mean a return to the anarchy of failed local pay bargaining. Providing we reach agreement through the current talks with the trade unions on a new pay system, any foundation hospital would be part of the new national pay framework.

UNISON also allege that we are contemplating bringing in what they describe as Railtrack style private sector management. This is not true. For the handful of consistently poorly performing hospitals we will change their top management team. Teams with a proven track record of successes elsewhere in the NHS will be brought in to turn the failing hospitals around. However, we should not close our minds to getting good managers from elsewhere. In time, that could include from local government, housing associations, the voluntary and charitable sectors, or parts of the private sector. This is not in any way, shape of form about privatising the NHS. No hospital and no NHS asset will be sold off. It is about getting the best managers into all parts of the NHS.

Our reform programme is not about undermining NHS values. It is about strengthening them. To make sure that the NHS can deliver more high quality care to more NHS patients more quickly. As you know, we are rapidly expanding capacity in the NHS – with more staff, beds, health centres and hospitals. In addition we are using spare private sector capacity to treat NHS patients where we can get. the right standards of care and good value for money. And by devolving power to the NHS frontline and giving NHS patients more choice over NHS services we are seeking to create a different sort of health service. An NHS where resources and responsibilities are taken out of Whitehall and into the hands of frontline staff. A health service which is true to its values and which is more responsive to the needs and choices of its patients.

The NHS Plan is the foundation for these major changes. I hope that UNISON and others will support them.

ALAN MILBURN

Secretary of State for Health

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