A little competition in health care may be a good thing, says York Hospital chairman Alan Rose – just not too much. He tells to STEPHEN LEWIS why.

ALAN ROSE chooses his words with care. So when the chairman of York Hospital talks about the risks of introducing too much competition into the NHS, you take him seriously.

We’re chatting about the impact of the Government’s programme of health reforms on the hospital.

Two tiers of NHS bureaucracy – primary care trusts and strategic health authorities – are being swept away. And in future, responsibility for deciding how local NHS cash should be spent will rest largely with GPs.

He’s not necessarily against that, Mr Rose stresses. But he does worry about the leeway that will be given to groups of local GPs to decide whether private companies should be invited to bid to run local health services.

There may be a case for a “degree of competition” in the NHS, he accepts. York Hospital, for example, has already won a tender to continue running physiotherapy services, by making sure they would be more community-based. But he doesn’t think competition should be pushed too far.

Inevitably, the process of tendering for physiotherapy services was disruptive. It was manageable, because physiotherapy only represents a small proportion of what the hospital does.

“But if a large proportion of our services were put out to tender it would… fragment the integrity of local health care delivery.”

That may be a slightly corporate way of putting it, but it is clear he doesn’t think it would be good if too many private companies were trying to cherry-pick the most profitable parts of the health service, forcing organisations such as York Hospital to devote time and resources to tendering for services.

With GPs set to hold the financial purse strings in future, he sees them as key to ensuring that doesn’t happen locally.

In York, once the reforms settle, we are likely to be faced with a consortium of up to 300 Vale of York GPs taking responsibility for health spending in the York and Selby area. There are likely to be other, similar-sized consortia in Ryedale and Scarborough.

The success of the reforms, Mr Rose says, will depend partly on the leaders of those consortia being ‘well-intentioned’.

It’s an odd word to use, although he insists he chose it deliberately. It seems to suggest he thinks some local GP leaders might be less than well-intentioned. So what does he mean?

“It needs to be carefully considered when competitive processes are appropriate in the local health economy,” he says. “Forcing large elements of the health service to be exposed to competition could be highly disruptive to local health service delivery.”

Again, the language is a bit corporate, but the meaning is clear: a little competition may be fine, just not too much. There are health services, he adds, that it would be “completely inappropriate” to put out to tender – including A&E, intensive care, and acute services such as cancer treatment and heart care.

Despite his concerns, Mr Rose doesn’t agree with those who believe the Government’s health reforms are a way of privatising the NHS by the back door. “I believe that fears of privatisation of the NHS have been exaggerated,” he says.

Nevertheless, at least until they settle down, the health reforms have introduced uncertainty into the NHS. And in York, Mr Rose says, that is compounded by two other major challenges.

Over the course of this year, the hospital has to cut something like £14 million from its £300 million-a-year budget. That amounts to a cut of about five per cent, on top of earlier cuts made last year. That will inevitably result in some rationalisation of health services. The recent drive to prevent people coming to A&E when they don’t really need to is an example.

Will it also lead to job cuts in the hospital’s 5,000-strong workforce? There is a natural turnover of staff in York that should make it possible to restructure without disrupting services, he says. So…? “We are doing what we can to manage the efficiencies in a way that minimises redundancies.”

That process will be helped by the third big challenge the York Teaching Hospital Trust faces, he says.

Over the next year or so, the trust will be massively expanding.

Already, it has taken over responsibility for running the community hospitals in Selby and Easingwold, as well as other community-based health services, such as health visitors and community nurses.

There are real benefits to that, he says: it makes it easier to co-ordinate health care, ensuring people can be treated in the community if appropriate rather than coming into hospital, and also that when they are discharged from hospital they continue to get the care they need in their own homes.

“It should all be more joined up.”

From next April, if all goes to plan, there will be a further expansion: York Hospital will take over running Scarborough and Bridlington hospitals, along with Malton and Whitby community hospitals.

If that happens, the Trust will be responsible for seven hospitals, as well as community services. The number of staff it employs would increase from about 5,000 to between 8,000 and 9,000.

But it will also give greater scope for reducing inefficiencies, Mr Rose says – and so for reducing spending without affecting services.

Scarborough Hospital’s past problems – including once being labelled the worst hospital trust for patient safety in the north of England – are well documented.

But big strides were made last year. And this won’t be a takeover, Mr Rose insists. Good practice will be shared, but Scarborough Hospital will keep its own identity. Scarborough patients needn’t worry about being asked to travel to York, either, he adds. The new, expanded York Hospital Trust will be for the whole of York, Ryedale, Scarborough and Selby, not just focused on York. “The aim is not to have lots of patients moving. If anything, we want to take services to people.”

So might York consultants spend more of their time travelling to Scarborough? And if so, won’t they spend less time in York? “There may be a bit of that. But that can be accommodated.”

All in all, this adds up to huge change in the health services locally.

Mr Rose heaps praise on hospital staff for the way they have continued doing their jobs despite all the uncertainties. “They should be congratulated.” Morale, he insists, remains pretty good. There is worry about the uncertainties facing the NHS, but also a “generally positive outlook at this particular trust.”

And how about himself?

“I’m an optimist. I’m upbeat about the future sustainability of this trust, and of health care in our area, despite the very challenging years ahead.”

What illness taught Alan...

ALAN Rose never set out to become a hospital chairman. It was a sudden, shocking change in his life circumstances that brought him here.

For a long time, he was a high-flying businessman. After graduating from Edinburgh University with a degree in economics, he worked for with oil giant Shell. His wife was then offered a job on Wall Street, with Chase Manhattan bank, and the pair moved to New York.

He did a postgraduate degree in business, then got a job as a strategy consultant for a company called Booz Allen International. For 12 years, he was an international problem-solver, advising major companies on such things as the best strategy for building gas pipelines in the Middle East.

By 2001, he and his wife were back in London, and he was a partner in the firm. Then came that life-changer. He was diagnosed with non-Hodgkins lymphoma, a form of cancer. “It was devastating really – to me, and my family, and the people I worked with,” he says.

He underwent five months of chemotherapy followed by radiotherapy. He had to take a year off work: and at the end of that, was advised not to go back to his stressful job. He found he didn’t really want to.

“My whole perspective on life changed from that moment,” he says.

He and his wife by then had two children. They decided on a new lifestyle – and moved to York, where he set up his own landscape gardening business. They didn’t know much about York, but from what they’d heard, it was a “good place for children to grow up”.

Then, in 2006, York Hospital advertised for a new non-executive director to join the board. Mr Rose applied, and was appointed. That was probably more to do with his business skills than his gardening skills, he jokes.

Fourteen months ago, when Alan Maynard stepped down as hospital chairman, Mr Rose took his place.

He has been in remission from cancer for ten years now. But his illness gives him a perspective he wouldn’t otherwise have, he believes.

“It gives you some insights into the dramas going on in people’s personal lives, into the traumas and tragedies going on in the lives of thousands of people walking through our corridors every day.”

As chairman, he is not a decision-taker, he stresses: the chief executive, Patrick Crowley, is in charge of the day-to-day running of the hospital. As a non-medical man, Mr Rose doesn’t see it as his job to interfere. But he does chair board and governors’ meetings, and helps set the tone. “I can influence the mood, and try to ensure that we spend our time on the right things.”

As far as he’s concerned, that means focusing on patients and their experiences in hospital. And not only the medical care, although that’s important.

“You have to care about the car park, the food, the behaviour of staff towards patients, all these things as well,” he says.

Spoken like a man who has seen health care from the patient’s side.