Published: 03/06/2004, Volume II4, No. 5908 Page 19
Local government has not had much to shout about recently.
So we might forgive the chortling in town halls at the small number of people who voted in the recent elections for foundation trusts.
It is no surprise that many councillors see foundation trusts as a potential threat. The new localism could lead to many more local services run by bodies similar to the fledgling NHS organisations.
Of course, it is disappointing that more people have not signed up. But the turnout figure for the elections to the first-wave foundations was not bad and compares with the participation rates in local council elections.
My local trust - University Hospital Birmingham - has just been through a riveting election. Over 6,000 people voted in the patient constituency and as many as 787 nursing staff voted for their representatives. Trust chair John Charlton proved to be an assiduous lobbyist of health ministers last autumn in persuading them to free up the membership process. It has certainly paid dividends.
Birmingham has also produced some exciting elections in the public constituencies. In Selly Oak, top of the poll came David Spilsbury.He has been a stalwart of the South Birmingham community health council for many years and a vigorous critic of the private finance initiative. Look across to Edgbaston and Sir Dick Knowles was triumphant. A very sprightly octogenarian, Sir Dick is a former Labour leader of Birmingham city council, whose reign was characterised by a series of successful public-private partnerships.
To these can be added a number of powerful stakeholder governors. The list includes Sir Albert Bore, current council leader, the bishop of Birmingham, the vice-chancellor of the University of Central England, and local MP Gisela Stuart. Debate should certainly be lively. That is just how it should be. Foundation trusts represent the best chance the NHS has ever had of breaking free from Whitehall micro-management. But this will only come about if they are truly seen to be locally owned bodies.
Simon Stevens, the prime minister's highly influential health adviser (soon to depart for US company UnitedHealth), has recently argued that one of the lessons of the failed internal market is that in the absence of a legally binding lock on provider independence, central government tends to get drawn back into direct management of hospitals.He points to the independent regulator as the guarantor of foundation trusts' independence.
Just as important, though, is recruiting a large membership. For established foundation trusts, the temptation might be to sit back and rely on whatever membership levels they have already obtained.
This would be a big mistake. Their credibility is at stake and they should go all out to prove their local credentials.
Local authorities may be feeling a little smug about the difficulties some trusts have had in rustling up members. In the long-term, though, they may come to recognise that the emergence of a new breed of elected local bodies will inject much-needed enthusiasm into the democratic process.
Lord Hunt is chair of the National Patient Safety Agency and a former junior health minister.