focus on health
Remote monitoring of utilities promotes
responsible use of energy
For the past two centuries, we have been quite content to accept Benjamin Franklin’s view that “In
this world, nothing can be said to be certain apart from death and taxes”. Regular re-organisation of
the National Health Service could safely be added to that short list, however, based on the experience
of the past six decades. Certainly from an outsider’s perspective, none of those decades has
passed without radical changes in the way that state-funded health provision is delivered.
And while change for the sake of change is unnec- more closely integrated with it than the Govern-
essary and wasteful of resources, successive rounds ment itself feels is necessary for hospitals which
of re-structuring have seen responsibility for deci- can make a case for a more autonomous existence.
sion-making within the Service brought progres- NHS foundation trusts are the mechanism by
sively nearer to the patient ‘interface’ and away from which that more flexible mode of operation can be
the corridors of Whitehall. put into practice. Seen as being at the cutting edge
Within the current model for decentralisation, the of the Government’s commitment to the decentrali-
NHS hospital trust is a stable, ring-fenced piece of sation of public services and the creation of a pa-
the NHS jigsaw, widely regarded by health sector tient-led NHS, foundation hospitals have had deci-
analysts as a positive development which has sion-making devolved further from central government
brought more effective management of resources control to local organisations and communities.
to the hospital service. Normally spanning a group Applying the concept as it was intended creates
of between two and five hospitals within the same organisations which are more responsive to the
geographical area, these trusts operate at a scale needs and wishes of the communities they serve.
that allows them to provide a more comprehensive They become self-sustaining businesses able to
portfolio of services and facilities for patient care enter into material contracts in their own right, tak-
while securing economies of scale and diversity of ing out loans, for example, where these are consid-
skills within their ‘business’. ered beneficial to the business.
Hospital trusts are fine as far as they go, however. Foundation status is therefore an objective for
Whatever their trust status might appear to convey, most hospital trusts, and more than 100 have so far
they are still an arm of the NHS machine in England; made the transition.
The Informed Executive
45
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