Letter to The Health Overview & Scrutiny Committee

Kingston Hospital Trust’s presentation last night was exceptional! It was made in person by the Trust’s Chief Executive, Carole Heatly - marvellous! The bad news was that Richmond was represented by four members of the public. Two Councillors, it is true, from the Health OSC, but no one from the PPIF nor from the voluntary sector, its CVS or its VSCG.


The attached letter to this week’s Richmond & Twickenham is relevant - so are two letters of mine in August. The King’s Fund writes of “unleashing the bottom up initiative of the NHS”. Carole Heatly’s presence and performance offers hope - an exemplary demonstration of the commitment of the best of NHS managers. The problem is that the DoH forces the Carole’s of this world to give a higher priority to bureaucracy rather than management - and at vast cost.


In truth, Carole is being forced to be a bad manager. The clinical resources of Kingston’s new surgical centre are being inadequately exploited - over weekends. Why? The Trust can not market its services effectively - critical to retaining its university status (as we were told) - despite all the quality of its surgeons, nurses etc (and Richmond’s GPs)!! The Trust’s response to these failings is to pass its problems on to the private sector to resolve - a denial of its duty. The long term consequences of this dereliction have not been thought through.


The Trust and the NHS are ducking the bureaucracy v management problem:


(A) Will the private sector help the clinical quality of its surgical centre? If so, how?

(B1) Will it be charging customer PCTs less than the Whitehall rate?

(B2) Will it be imposing its own management structure on clinicians?

(B3) Will it impose its own recruitment and hierarchical structural rates of pay - and hours of work?


If the latter, in (B2) and (B3) and possibly (B1) why can not the Trust do the same? Goodness knows it has been given enough money and recruited enough managers to undertake the task. Finally the NHS CEO (sadly no longer), Sir Nigel Crisp laid down that “the pace of change would be subject to local consideration and consultation.” The 2008 date for Foundation Trust status must be postponed - and Richmond must do its best, through the Council (its voluntary sector), its PCT and the Kingston Hospital Trust.


A preliminary and rushed response.


Yours sincerely



Francis King