The status quo is no longer an option

On continental Europe, in countries where healthcare is funded by universal insurance, the health insurance companies drive efficiencies and value for money and the smart providers spot trends early and make the changes they believe will allow their hospitals to be sustainable into the foreseeable future, writes Denis Doherty.

Trusts are to be formed as a feature of the reformed healthcare landscape here. How significant is that likely to be and what role will they play? Well, details of what is planned are sketchy, so it remains to be seen.

Denis Doherty
Denis Doherty

Trusts have been a feature of the NHS in the UK for a number of years now. They fall into two categories, some are commissioning trusts and others are commissioned trusts. Commissioning trusts commission services from service providers but some also provide some services themselves. Primary care trusts come into that category. Commissioned trusts, the majority of which are acute hospitals, usually provide secondary and tertiary care services. Mental health and ambulance services are also provided by trusts. In Northern Ireland services are commissioned by a health and social care board and are delivered by six trusts.

The word trust can mean different things depending on the circumstances in which it is used. In the NHS, the current fashion is to apply the word ‘trust’ to public health bodies in much the same way that words like ‘boards’ and ‘authorities’ were fashionable in the past. A board, made up of executive and non-executive directors, governs each NHS trust. Interestingly, non-executive directors are appointed following public advertisement.

In the Netherlands, mergers, facilities replacement and major modernisation programmes are commonplace

Trusts are not a feature of the Dutch healthcare model to which we aspire. Eight University Medical Centres, only two of which are in Amsterdam, form the top group of hospitals. There is a similar number of non-university ‘top clinical’ hospitals and there are also many local hospitals.

Here, the recently formed hospital groups in the west and the mid west could become trusts like those in the NHS by the appointment of boards of governors. Public hospitals in some other areas could also be grouped without much difficulty. The greater Dublin area is, as always, more complicated. Voluntary Hospitals, Public Voluntary Hospitals and Public Hospitals make up the publicly funded hospitals network there. There is also a concentration of significant private hospitals in the Dublin area. Increasingly more secondary and tertiary care to the populations of midland and north – eastern counties are being provided by Dublin hospitals. There may be sufficient or even a surplus of hospital beds in Leinster but, many are in the wrong locations and others are in hospitals that are old and no longer fit for purpose. The major system changes that are planned add urgency to the need to rationalise hospitals in Dublin and much of Leinster.

Those who commission and deliver services are often well placed and willing to lead effective change. On continental Europe, in countries where healthcare is funded by universal insurance, the health insurance companies drive efficiencies and value for money and the smart providers spot trends early and make the changes they believe will allow their hospitals to be sustainable into the foreseeable future. In the Netherlands, mergers, facilities replacement and major modernisation programmes are commonplace. We have been reluctant to adopt change of that sort but it looks like the status quo is no longer an option.