NHS CONFEDERATION SCOTLAND Exper t compares foundations to 'warring city states'

Published: 14/04/2005, Volume II5, No. 5951 Page 12

A report intended to shape the future of the NHS in Scotland is likely to reject the key English reform of foundation hospitals, which its author compared last week to 'warring city states in preMachiavellian Italy'.

HSJ has learned that a first draft of the report of the advisory group on service change, led by David Kerr, Rhodes professor of cancer therapeutics and clinical pharmacology at Oxford University, was sent to Scottish health minister Andy Kerr last Thursday.

Professor Kerr's group was asked to devise a strategy to make Scottish health services safe and sustainable at a time when threatened hospital closures and rationalisation has led to unprecedented public and political opposition. The report is expected to favour a more co-operative approach (news, page 8, 31 March), relying on 'Scottish collectivism' rather than 'English contestability'.

Speaking at the Scottish NHS Confederation conference in St Andrews last week, Professor Kerr gave some hints about what would be in the report, due to be published next month, saying foundations would not work in Scotland.

'Foundation hospitals are like pre-Machiavellian Italy with warring Italian city states, ' he said. 'It is warfare, not working together.' Professor Kerr argued that in parts of Scotland where car ownership is low, patients would not be able to 'vote with their feet' and choose which hospital to use. 'It is a potential model of social exclusion. It wouldn't work in Scotland, ' he said.

Professor Kerr also suggested the market model would make it difficult to meet the objectives of national service frameworks, which require some co-operation.

But he had some criticism for current service delivery in Scotland, particularly where hospitals within a few miles of each other provide the same services. 'That is just doolally, ' he said.

The report will contain guidance for community health partnerships, the planning and co-ordinating bodies currently being set up to replace local healthcare co-operatives. Professor Kerr said: 'CHPs have fantastic potential, but It is all a bit vague at the moment...We'll try to put a bit of structure round them.' He said some internal forms of competition within NHS boards, perhaps using innovative ways of funding, could add essential 'grit to the oyster' and provide proper incentives to improve services.

But he spoke against highly centralised services: 'People in Scotland have told us they are prepared to travel for fancy things. But they do not believe they should have to go far to treat a varicose vein or go to Scotland's hernia repair centre for every hernia operation when this can be done really well and safely close to home.' Although he confirmed that a first draft of the report was in circulation, Professor Kerr said it was by no means set in stone and that he wanted the dialogue with patients and NHS staff to continue.