So, is the allegedly “loose wording” in the government’s consultation document on introducing a new power to (whisper it) allow the secretary of state to make suggestions to the foundation trust regulator Monitor a cock up or a conspiracy?
The Foundation Trust Network’s Sue Slipman points as an example of “loose wording” to the occasions listed in the document where the health secretary would “articulate his view as to what additional action Monitor might take.”
These occasions are listed as those involving patient safety, leadership, governance and public confidence. All but the last are already explicitly catered for by Monitor’s regulatory regime, so the regulator and FTN are concerned the new power could be used in more than just the “very small number of serious situations” alluded to in the document.
Thus hackles have been raised that this could be yet another plot to roll back on New Labour’s foundation trust legislation, by reasserting central control over these fledgling independent organisations. Bed pans in Tredegar have been raised, and those dangerous dogs are straining at the leash (the nasty bite this time coming from the jaws of Mid Staffs). In case that’s not enough, Ms Slipman has also thrown in judicial review.
But if it really is bed pans and Rottweilers at dawn time again, should that be a surprise? According to pollsters, the NHS is consistently the number one thing that makes Brits Proud To Be Brits – a metric politicians of all hues are acutely sensitive to.
Monitor and the FTN are hoping the wording is the work of an over-eager civil servant, who will be slapped down - sorry, clarified - in the final draft. But the other option is to think of the job description analogy. Mine, if I recall correctly, goes something like: find things out, write things down, do print, do web, cheerily take part in the tea making round, AND ANYTHING ELSE WHICH OCCURS TO THE BOSS.
Drafting new legislation, against the background noise of Mid Staffs, swine ‘flu, financial Armageddon and an election, it doesn’t seem that much of a surprise that the DH might sneak in their own little “and anything else” – it’s a legislative “just in case”.
Of course that won’t calm Monitor’s or the FTN’s nerves. In addition to dangerous dogs and bed pans, the spectre of a future despotic and malevolent government is never far from this breed of concern.
But the question is: how much difference would a new loose power make in practice? Surely, in effect, the “anything else” caveat has always been there, just more hidden, in the Treasury’s Managing Public Money rules, to which FTs, along with everyone else, has to abide.
It’s these rules NHS chief executive David Nicholson recalled last June when asked by the Public Accounts Committee if he really was going to tolerate dozens of FTs breaking away from the NHS’s block £12bn IT contract (NPFIT) to pay for their own systems. He described them as “very clear about taking account of the impact on the wider public sector finances,” – his implication being: we have the small print to stop an FT spending NHS money in a way we don’t like.
The actual wording states that public bodies should manage public money according to the principles of “the public interest” and “achieving value for money”. Sounds a bit, well, loose. Isn’t “patient safety, leadership, governance and public confidence” positively tight in comparison?