Failing to build a foundation of trust

When a foundation hospital cocks up totally and absolutely, which has happened all too often in the past two years, how should the managers persuade the patients that they will be cared for properly in the future? A tricky job, but how not to do it was demonstrated graphically by the foundation hospital trusts called to account by last week's BBC radio File on Four programme, 'Foundation hospitals: an acute crisis' ( link to audio and transcript ). All of the foundation trusts under attack – Goole, Gloucestershire, Dorset and Slough – chickened out of an interview with the presenter Julian O'Halloran. Instead, they offered written statements, full of macho managementspeak, about new teams taking "robust financial measures, leading towards a surplus in the next few years". These statements reminded me of the same sort of clichés served up by Mid Staffordshire, Colchester and Basildon foundation trusts when they had been exposed last year by horrific evidence of execrable patient care. Why do they do it? Why do they think that this kind of blah will convince anyone? Why haven't they got the guts to face the press and explain in words of one syllable what they did wrong, and what specific things they are doing to get out of the mire? This is difficult, and needs presentation skills of a high order, but is the only way to restore credibility. Patients and Radio Four listeners are not fools. Having said all that, a spokesman for Monitor, the regulator of the foundation trusts, did appear on the programme – and cocked up. So did the guy from the King's Fund who thought up the whole Foundation Trust idea. So did Andrew Lansley, the minister, who wants to give all hospital trusts foundation status in three years. All tried to defend the indefensible. The Monitor guy claimed that his organisation had got the balance between regulation and letting the trusts do their own thing "about right", despite 11 hospital trusts being in breach of acceptable financial standards. Monitor had admitted Dorset to foundation status despite several years of deficits. If I were a patient of one of these 11 hospitals who had been refused a bed because a foundation Trust had overspent, I would question Monitor's judgement and competence. Or reckon that the whole foundation Trust concept was fatally flawed. I would have expected that the Monitor spokesman would have at least agreed that its processes needed tweaking. Instead, he left the impression that Monitor was a toothless watchdog, fawning on the hospital administrators. Andrew Lansley, too, wants to push on regardless. I was amazed that he didn't blame the Labour government for putting too high a value on financial targets and too little on top quality patient care. And he could have said that he was going to adjust that balance. But he didn't, saying that good patient care was the responsibility of the Care Quality Commission, not the foundation trust process, which was there to judge a trust's "corporate and financial strengths", and drive up standards through competition. So, he is going to drive ahead in the same old way with his plan to turn all hospital trusts into foundation trusts within three years. A BMA man on the programme described the speedy plan as "foolish". And an ex-hospital administrator called it "barmy". Perhaps Andrew Lansley should have kept his mouth shut, instead of exposing himself as an ideologue who does not want to be blinded by unpleasant facts. I have come to wonder why these organisations are called "trusts", when their spokespeople do their best to destroy trust.