A ga-ga-ga bureaucracy

If a hospital invites babies to take part in its consultation process, the NHS must be unwell

My nine-month-old son, Will, has just received his first letter in the post. A postcard from his doting granny, perhaps? A fat cheque from his godmother? No, a letter from the NHS, asking if he would like to become a member of the NHS foundation trust at the Chelsea and Westminster Hospital on London's Fulham Road. It was titled, in bold type, "Invitation". Will and I were intrigued and not just a little flattered.

The NHS was writing to Will, it continued, because he had recently been a patient at the Chelsea and Westminster Hospital. This was correct! He had indeed been a patient at this hospital - by virtue of being born there. They obviously knew him as something of a genius child, because they offered him a chance to discuss the provision of NHS services at regular community meetings and - should he so wish - he could even stand for election to the members' council. The trust, the letter went on to assure us, would be accountable to the local community as a whole and really make my son feel that he was having his say. Presumably even if his say was "ga ga ga".

I soon found out that all the mothers in my antenatal group had received invitations for their babies, too. More than 4,000 babies are born at that hospital each year, so if you send a letter to all of them, plus their mothers (I also received the invitation), that's £2,240 in postage. Not counting the paper, the envelopes, the labour involved in drafting and printing the letters. Then there's the cost of establishing and maintaining the explanatory website to go with the invitation, which features no fewer than ten languages (including Albanian and Farsi). And the cost of an interpreter helpline in case you don't speak any of those languages.

The invitation states that my son might have noticed that the government is giving certain hospitals the chance to become foundation trusts. If he had not, the multilingual website was at hand to cure his ignorance. It turns out that the hospital in question is not actually an NHS foundation trust yet, but it hopes to be one by October. As part of this hopeful process, it is contacting its potential members (they mean patients) to ask them for their contribution. We were being involved in the "consultation process"!

This was heady stuff. Still more important, I read, was the government's aim for every single NHS trust (for this, read "hospital") in the country to become an NHS foundation trust by 2008. Foundation trusts, as I understand it, get to run their hospitals like a business, without state interference. They can do whatever they want, providing they still offer NHS services and providing they consult their members' council (composed of patients - sorry, foundation members).

It makes sense, in theory. Until you remember the invitation. I have a sneaking suspicion that although NHS foundation trusts were conceived to circumvent bureaucratic interference, their creation will in fact result in yet more paperwork and waste-of-time multiple-choice forms sent to nine-month-old babies. When I dug a little deeper on the net into the NHS's sugary sweet culture of what it calls "involvement", I found myself in the scary Soviet world of "patient and public involvement forums", "patient advice and liaison services" and "independent complaints advocacy services". Do we really need members' councils with elections, meetings and consultative processes on top of this existing administrative colossus? The baby invitation is simply a symptom of a giant problem.

It is as if there have to be more procedures in place for complaining, "making your unique voice heard" and feeling included than there are for actually receiving medical treatment. To use the language of their literature, I am afraid that I do not "so wish" to have a say in how NHS services are provided or how the hospital is run. I do not want to have control over the direction the hospital is taking as a healthcare provider. I do not want to have more freedom to shape the services. I do not want anyone to seek my views or consult me. I do not want to have patient input. All I want is to know that if I get ill I will be cared for.

Instead of spending more than £2,000 on consulting the nappy-wearing members of the community on their views, any spare money should be spent where it is needed - on medical services. Those services might just be affordable if all the money is not spent on consultation procedures and a comprehensive complaint structure.

Just for the record, Will won't be standing for election quite yet (although the envelope tasted quite nice - thanks).

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