143 Primary Care Trusts and NHS Trusts have been abolished and now we have NHS Foundation Trusts throughout the country. The health of these Foundation Trusts is at risk.

Cuts in health services have left many hospital trusts in sheer desperation. Accident and Emergency departments are at the top of the list as cutbacks are forced on the NHS and thereafter the ball starts rolling to close services down. Closing A & E departments is the first step towards the closure of the whole hospital. Once A & E departments close other services will be pinpointed and thereafter, gradually closed, such as maternity units, paediatric units, intensive treatment units, high dependency units and coronary care departments. In addition, women’s care services and trauma centres including orthopaedics will also be on the hit list. Supporting services also are at risk and will gradually wither away which makes it harder for Trusts to recruit appropriate medical staff and qualified nurses. Who wants to be employed by a Foundation Trust with a limited lifespan? NHS employees have mortgages to pay and families to support and financial uncertainty is an unwelcome career interruption when they have spent many years training to be a nurse or a doctor or indeed many years employed by the Trust.

In London alone, four accident and emergency units namely, Central Middlesex, Hammersmith, Ealing and Charing Cross face closure as well as St Helier Hospital, Chase Farm Hospital in Enfield and St George’s Hospital in Ilford. Up and down the country there are other hospitals facing closure such as hospitals in Rugby, Greater Manchester, Hartlepool, North Allerton, Newark, Redditch, Rugby, Stafford and Kidderminster. Some of these hospitals have brand new accident and emergency units including the Central Middlesex Hospital whose A & E unit cost £62 million not too long ago.

Queen Mary’s Hospital in Sidcup is also on the way out. The South London Healthcare Trust is struggling to deal with the burden of financial disaster. The Trust hospitals cost about £210 million to build and their closure will lead to lack of services for a million people in South East London. Apparently, administrators have now been brought in to deal with all the financial issues and sort out what is to be done to deal with the hospital’s massive debt which is believed to be in the region of £2 billion.

Monitor is an independent regulator of NHS Foundation Trusts. The organisation was set up in January 2004, to authorize and regulate NHS Foundation Trusts. Monitor is completely independent of the government. However, it is accountable to Parliament and its role is to decide when NHS Trusts are ready to become Foundation Trusts; and when they are, to support them and ensure that they are financially robust. The National Health Service Act 2006 provides information on Monitor’s functions and powers. In particular, sections 52 – 54 of the Act gives the Secretary of State and Monitor capability to declare a Trust insolvent and confiscate its assets for them to be dealt with by others.

A page on Monitor’s website lists risk ratings for all 143 Foundation Trusts. The highest scores for a Foundation Trust are 5 for finance and green for governance. Essentially, a high score means that there are no issues with regard to governance and shows that the Foundation Trust is financially stable. However, if a Trust scores red for governance and 1 for finance it is much more serious and leads to the likelihood of being placed in administration; being forced to merge; dissolved or sold off to the highest bidder. Monitor can demand that a Trust declares itself insolvent and any assets and liabilities can be placed with a Secretary of State for Health.

It would appear that savage cuts undermine local NHS services and can significantly hamper the quality of care in those services which do survive. The knock on effect is that bids for private contracts are available and private companies such as Virgin Healthcare, Serco and other private companies are looking to hive off the desirable sections of NHS funded services while the remaining complex, costly and risky parts of the NHS is what remains of the public sector.

In Devon, Virgin Healthcare has contracts in community healthcare, primary care and even sexual health services and child health. Serco also seems to be doing well in Cornwall. However, there still remains doubt as to whether or not the service Serco provide under these private contracts is acceptable. It would seem that theses private companies are making money out of the failure of the NHS Foundation Trusts and cherry picking the services that they want to buy up and subsequently provide.

In other areas NHS budgets are frozen. The effect of this is that the Trusts have less financial capability and they are then unable to provide adequate services. NHS Foundation Trusts can enhance their budgets with private medicine and data has revealed that up to 49% of income for NHS Foundation Trusts can come from private sources.

It has been suggested that these cuts are premeditated and that the whole crisis has been formed to open up the country’s most popular public service to profiteers.

Figures from the National Audit Office reveal that the Department for Health gave emergency funds to four NHS Foundation Trusts and 17 NHS Trusts between 2006 and 2012 so that they could pay staff and creditors. Of these payouts they include £356 million to South London Healthcare NHS Trust (incorporating Queen Mary’s in Sidcup) after it was declared bankrupt by the Government. Accordingly, none of this payout has been repaid to the Department of Health by the NHS Foundation Trust.

Worryingly, another London Trust that regularly comes under my radar, Barking, Havering & Redbridge University Hospitals NHS Trust was paid £195 million by the Department of Health due to its financial difficulties. I personally have many cases against Barking, Havering & Redbridge University Hospitals NHS Trust and issues regarding safety at that hospital have been in the news for many years.

This all seems so far removed from when the National Health Service was created by the National Health Service Act in 1946 offering free treatment to individuals in England and Wales. The future of the Foundation Trusts and the NHS Trust is unstable, services are likely to continue to be limited and access to treatment difficult for some. However, for others with private healthcare insurance, they may benefit as private healthcare continues to thrive.