Remember foundation hospitals? Two years ago they were paraded as the government's big idea for reform of the NHS. Alan Milburn, then health secretary, wanted high-performing NHS trusts to be able to break free from Whitehall control, with scope to innovate and invest in improving services. He lost a battle with the chancellor, Gordon Brown, who limited the foundations' power to borrow. But Milburn's successor, John Reid, triumphed over Labour backbench rebels who wanted the whole experiment stopped in its tracks. By 2008, every NHS acute hospital was to be in a position to apply to become a foundation - or so he promised.
Since April last year, 32 NHS trusts have gained this cherished status and most have prospered. But, strangely, they moved off the political radar screen as ministers raced on to their next big idea. Debate is now focusing on how far the private sector should be allowed to penetrate the NHS marketplace and compete against NHS providers - both the foundations and traditional district hospitals.
Foundation chief executives are feeling forsaken. Once the favoured sons, they have been more or less sidelined as ministers lavish attention on the new, private sector baby.
Enter Sue Slipman, the former Communist leader of the National Union of Students (NUS) who crossed the political spectrum to become a founder member of the SDP in 1981, aligning herself with Labour rightwingers who despaired of their party's lurch to the left.
Now she works for the NHS Confederation as director of the Foundation Trust Network, committed to winning for the foundations the right to compete against private operators on equal terms.
Slipman, a down-to-earth dynamo with an irreverent sense of humour, does not mince words about the foundations' plight. "We have been in limboland while the government got its head around what the system is going to look like," she says. Lots of important questions remained to be answered before the foundations (and the banks) could be sure they were competing on a level playing field. It was time for the government to "get a blinking move on" and sort them out, she adds.
Guiding principles
Some critics think Slipman has been too politically footloose in the past to be taken seriously. They question the consistency of someone who was in the Communist party until 1979 and in the SDP until it expired in 1987, and believe her subsequent career moves through organisations as diverse as the National Council for One Parent Families, the Gas Consumers Council and the lottery operator Camelot show a bewildering capacity to zigzag.
To Slipman, however, the journey has been guided by constant principles. "I was a working class girl from Brixton," she says, recalling her upbringing in south London where her parents ran a pie and mash shop. "I cared about opening up opportunities for people who didn't have them.
"I'm talking about the late 60s and early 70s when everyone took 10 steps to the left whenever they entered the door of the NUS conference. I was a Euro-communist. It was a sensible place to be, to avoid getting crushed by the Stalinists or Labour. We were interested in moving away from state planning to produce a more pluralistic society."
Slipman sees that ambition as the consistent thread of her career. After the NUS, she became a negotiator for Nupe, one of the public sector unions that later merged to form Unison. She joined in 1979 and lasted six years, in spite of efforts by the old guard to have her sacked.
She says joining the SDP did not amount to a change of political view. "The strands of what I am interested in have been consistent throughout. The SDP was about thinking through effective strategies to improve social justice in a way that was economically viable."
As director of the National Council for One Parent Families from 1985 to 1995 (during which she became a lone parent herself), Slipman campaigned for social justice and job opportunities. Then, as director of the Gas Consumers Council, she saw her role as protecting the vulnerable minority who would not otherwise have benefited from the competitive market opened up by privatisation. At Camelot, she was responsible for conducting a social and ethical audit of the company. Where, Slipman asks, is the inconsistency in that?
When she was headhunted for the job with the Foundation Trust Network, she saw it as another chance to explore how economic efficiency could be combined with new forms of democratic accountability. The foundations are non-profit organisations governed by boards elected by patients and staff. In that sense, they are more rooted in their local communities than most NHS institutions.
She says she was delighted to get aboard "the rollercoaster of system change in health". The ride is "potentially scary" and the problem - for the time being at least - is that the foundations are having more downs than ups.
"The government accepts that we need a critical mass of foundation trusts before NHS growth money runs out in 2008." Had ministers provided the right encouragement, a majority of the 170 acute hospitals in England could have become foundations within three years.
The first step had to be to set a more sophisticated method of fixing the price the Department of Health pays for treatments provided by hospitals. Under the new regime of payment by results, they work to a set national tariff for each type of operation. But, says Slipman, the tariff is not sophisticated enough. Often it benefits hospitals doing routine work and fails to cover the cost of specialist departments treating more complex cases.
Fair tariff
The foundations wanted to borrow to expand specialist expertise. Before they could do that, they needed the certainty of a fair tariff, set independently at arm's length from ministers. "We need to make it attractive to become a foundation trust and for that we need a level playing field. So the government has to stop advantaging the private sector at our expense."
Slipman disapproves of private hospitals being allowed to bid to run treatment centres with guaranteed volumes of work when foundation trusts are excluded from tendering. The foundations, she believes, should be allowed to extend their reach to offer medical services in the community.
Foundations are bubbling with ideas for joint ventures with other NHS hospitals, claims Slipman, but they need the government to set ground rules. No policy exists on whether hospitals could merge to strengthen their management. It is not clear how ministers might deal with the failure of a trust that could not attract enough patients. They want to protect essential services from the rigours of competition. But which services are essential and could some survive without the back- up of specialist services?
The foundations, says Slipman, need clarity about the market so they can begin to prepare five-year plans. "We are asking health ministers to think about us in everything they do. We are not demanding the earth - just a level playing field and freedom to get on with it and achieve our potential. We have to make critical mass by 2008 and they are running out of time."
Curriculum vitae
Age: 56
Education: 1968-71: University of Wales, BA English; 1973-74: University of London (PGCE)
Career history: 2004-present: director, Foundation Trust Network; 1998-2002: Camelot, various positions including external relations and compliance director; 1996-98: director, Gas Consumers Council; 1995-96: director, London TEC Council; 1985-95: director, National Council for One Parent Families; 1979-85: negotiating officer, National Union of Public Employees (Nupe); 1975-78: national president, National Union of Students
Lives: South-east London
Interests: Spanish language and culture, theatre
