19 december 2010, first in, first out

Few worlds are worse than british health for throwing up their own impenetrable lexicons and structures, but two years after being appointed (bottom of page) to the board of a hospital, I have just about learnt the difference between a pct, sha, pbc and pbr. Just as a new government has decided to scrap them all. Hospital of course is a simplification - I'm actually on the board of a healthcare trust, or acute provider, which manages 3 hospitals (one is altrincham, in a terrible state, which we've spend huge efforts to convince our funders to let us rebuild), the main one of which, trafford general, is whose doors the first patient of the much-fabled national health service walked through. It's also the centre of a great deal of planning that made it cutting edge today in the uk for providing "integrated care" essentially between general practitioners (the local gatekeepers), the pct (who commission) and our trust. Now however, such trusts need to move rapidly towards becoming semi-independent, or "foundation" trusts, supposedly more communal "patient-led" organisations, freer from central control. A smallish trust like ours, it seems, can't possibly make the grade, despite an absolutely excellent recent safety record, having a very good senior management team in place and being named medium-sized trust of the year for the whole of england. So we were one of the first to signal it is looking for a partner to merge with or acquire it, although there are actually many models this headline description could follow. Whilst everyone wants an administrative structure that provides the best outcome for our community - quite possibly no local structure at all - divining what that is will be the stuff of many debates over the coming, interesting, months.