Interview

Keen on collaboration, not competition

The NHS Support Federation remains in the front line of the battle to win the argument over the government’s NHS reforms. Its chair, Professor Harry Keen, spoke to healthmatters

Guy’s Hospital Trust is an unlikely starting-point for a revolution that will sweep away the Conservatives’ NHS reforms, and Professor Harry Keen is an unlikely revolutionary. The hospital is the usual quirky conglomeration, poorly signposted and evidently unplanned, much like the NHS itself. Professor Keen is quiet, thoughtful and charming, although clearly knowledgeable and determined. Every inch a teaching hospital consultant, in fact. Yet he, from his base in a trust flagship, has become the leftish demon that Tory papers must denounce and health ministers bombard with criticism.

When I asked him about his notoriety he talked about the NHS Support Federation, of which he is chair. ‘The Federation is dynamic and has an impact because it brought together local campaigns working against the market place ideology of the White Paper, whilst staying clear of any party political allegiance. We are cross-party and cross-sectoral, with Conservative party members active in our campaigns and even some NHS managers quietly supporting us.’

’We are effective, which is why the government attacks us to vigorously now. The newspaper adverts we ran in The Observer, when consultants and GPs signed up to criticise the Government’s health service reforms, had a powerful impact. So did the candlelight vigil last autumn. About 10,000 people took part up and down the country, and the amount of local press and radio coverage we got was enormous.

There is little doubt that the NHS Support Federation has now moved centre-stage, eclipsing the BMA and attracting more government flak than even the NHS trades unions. Harry Keen is sure he knows why this has happened. ‘The BMA has stepped aside from the conflict with the government over the NHS and left us as the main focus of resistance. Inside the health service, and particularly in medicine, there is some grudging acceptance of and adaptation to the reforms. This is understandable, and I am sure it explains why the BMA has toned down its criticism of the changes. Many NHS staff feel the need for stability and want to get on with their work, to the extent that I detect some worry that a new government might want to undo the reforms and initiate more major change, with all the disruption that would follow’.

That struck me as a potential problem. Should bad reforms be kept in place, despite their destabilising effect on the health service, so that NHS staff could have a sense of security? ‘The old NHS lacked opportunities for local initiative to be expressed and for things to change, partly because it was underfunded but also because of the rigidity of the funding structure itself. It needs enterprise and initiative, and a willingness to take some risks. I think we should extract these things from the reforms that is government is attempting to impose on us and build upon them, but making collaboration for health the theme, not competition.’

What does that actually mean? ‘The government should promptly take out the market mechanism and replace it with a collaborative, co-planning, resource management approach. The ‘purchaser-provider’ split would be convertible to allow this, but it should be modified to incorporate the social dimension of health and illness. That means involving a number of community agencies in setting up, funding and monitoring performance agreements.’

’The commercial, confrontational model creates a damaging division between health care professionals and contract negotiators. I do not think that contractual relationships are in themselves a problem, but they need to focus on resources rather than money, and the open assessment and prioritisation of needs must be at the centre of the relationship. The NHS cannot make money, after all, but is must spend it wisely and well.’

Is there not a danger that a Labour government would fail to fund the NHS adequately? ‘There should be increased funding for the NHS, but also a new NHS body — perhaps a special health authority with strong regional delegation and a substantial budget — responsible for promoting innovation and change.’

What did he think the NHS Support Federation would do next? ‘We have been getting and distributing information about what is happening in the NHS, but this is becoming harder and harder to get, especially from the trusts. The shift away from clinical direction to commercial direction has been enormous.

Information is made available on a “need to know” basis and clinicians as a whole are seen as “not needing to know”. In any case in the health authorities the lid has been firmly shut on anything other than vacuous upbeat pronouncements, and woe betide anyone who steps out of line or speaks out of turn’.

’We will continue to respond to the smear campaign against us, and will seek to engage the Conservatives in serious debate about the NHS. We will continue to draw attention to and call for the withdrawal of Paragraph 14 of the 2nd Schedule to the 1990 Act — the “privatisation clause” — which enables trusts to sell their best NHS services to the private sector. The most crucial task now is to get information about what is actually happening to the NHS, and to the trusts, and to make it public. healthmatters readers could help us a lot here and we would like to hear from them.’