NHS foundation trust

An NHS foundation trust is part of the National Health Service in England and has gained a degree of independence from the Department of Health and local NHS strategic health authority. Foundation Trusts are represented by the Foundation Trust Network, .

Function

Foundation trusts have a significant amount of managerial and financial freedom when compared to NHS hospital trusts. The introduction of NHS foundation trusts represented a change in the history of the National Health Service and the way in which hospital services are managed and provided.

This form of NHS trust is an important part of the United Kingdom government's programme to create a "patient-led" NHS. Their stated purpose is to devolve decision-making from a centralised NHS to local communities in an effort to be more responsive to their needs and wishes.

Foundation Trusts are considered mutual structures akin to co-operatives, where local people, patients and staff can become members and governors and hold the Trust to account. For example, Blackpool Fylde and Wyre Hospitals NHS Foundation Trust has 31 Governors, made up of Appointed, Public and Staff Governors who act as a key link between patients and the public and the Board of Directors.^[1] Some trusts are more committed to co-operative principles and have even written the Rochdale Principles into their constitution and aspire to work closely and in partnership with other mutual as well as local organisations.^[2]

As of November 2011 there were 140 NHS foundation trusts. They are authorised and regulated by Monitor, the independent regulator of NHS foundation trusts. They include acute trusts, mental health, community and ambulance trusts. A full list of NHS foundation trusts can be found on Monitor's website.^[3]. With the authorisation of North East Ambulance Service in November 2011, the North East became the first region with all trusts having gained foundation trust status.

Equivalent Foundation Trusts (eFT)

Formerly referred to as Foundation Trust equivalent (FTe), this designation applies only to trusts providing high secure psychiatric services. There are just three: Nottinghamshire Healthcare, West London Mental Health NHS Trust and Merseycare. Nottinghamshire Healthcare gained Foundation Trust standard on 2 November 2010. The other two trusts are in the assessment process.

These trusts abide by the same Department of Health definition for a Foundation Trust but there are important differences: the Secretary of State for Health maintains a direct line of communication and accountability with them through their appropriate SHA. This requirement is needed because the Secretary has the responsibility to provide healthcare to patients who have been detained under the Mental Health Act, and have been judged to pose a grave and immediate danger to the public. Unlike full Foundation Trusts, equivalent Foundation Trust organisations have a developing role:

Governors have no statutory role.

The Board of Directors have no statutory duty towards the governors.

The governors cannot, without the Board of Directors' permission, have any control over the direction of the FT.

The governors cannot appoint or remove trust auditors.

The chair and directors are not appointed by their board of governors.

There is no private patient cap.

Equivalent Foundation Trust organisations are still regulated by Monitor, and can retain surplus cash and can sell property and retain the cash from the sale. Their Strategic Health Authority monitors their forensic standards on behalf of The Secretary of State who will only use his or her direct channel in special circumstances.

Comparison with other hospitals

Unlike hospitals outside the NHS, Foundation Trusts currently have a cap on the proportion of their income that can come from non-NHS treatments. So, the private patient income cap is, in fact, a misnomer. It does not only apply to income derived from individual patients, it covers income from all non-NHS sources. This can include joint ventures to develop medical technologies, employers paying for counselling services or income from treating UK military personnel overseas.

Each FT has its own cap, set at the level of its private activity when the first FTs were established in 2003/4. About three quarters of all FTs have a cap of 1.5% or less. Some FTs have caps set at 0.2% of their turnover, a small number have caps set at between 15 and 30%. Until 2010 all mental health trusts were completely barred from undertaking non NHS work, but they now have a 1.5% cap. The Health and Social Care Bill introduced into Parliament at the end of 2010 includes the abolition of the private patient cap. At a time of such constrained public spending, abolishing the cap will enable FTs to bring much needed resources into the NHS.

Foundation Trusts also have different reporting requirements. They produce their accounts under the Foundation Trust Financial Report Manual, which is collated and authorised by Monitor, in liaison with HM Treasury.

History

Foundation trusts were announced by Health Secretary Alan Milburn in 2002.^[4] By April 2011, the Monitor website listed 137 Foundation Trusts.^[3]

The Health and Social Care Bill 2011 proposes that all NHS Trusts become NHS Foundation Trusts or part of an existing NHS Foundation Trust by April 2014.

Initial Reservations

At the outset some critics pointed out that Foundation Trusts go against the spirit of the principles laid out by Aneurin Bevan (who founded the NHS). Others feared that it would lead to a two-tier system. ^[5] Others doubted whether the Foundation Trust Members would succeed in having any effective influence over hospital management. A study undertaken in 2005 by the King's Fund of Homerton University Hospital NHS Foundation Trust found some governors disappointed and disillusioned.

“	I regret to say that I wouldn't be able to pinpoint a particular point or issue that I have been able to achieve by my being a governor.	”
—Homerton University Hospital governor

Another report found that it was too easy to invite members to sit on sub-committees, where they quickly became bogged down in the minutiae of operational planning, whilst the main decisions were taken at meetings that they only heard about after they took place.^[6] This study was funded by the Nuffield Foundation.

Measured outcomes

In furtherance of an evidence-based NHS, it was only normal that a study of the effectiveness of decentralisation from State control would be undertaken. In July 2011 the first fully independent study was published. Now with data from a cohort of 137 FT's available for analysis, rather than the first few hospitals to achieve status, a statistically more meaningful picture can be seen. This showed that the better figures recorded by the first trusts to reach foundation status, were due to factors already in place before the introduction of the FT initiative. This is also the likely reason that they were quick to gain trust status. The initial promising results were thus not repeated by all the other trusts which eventually were given permission to become a foundation trust. This appears to support the opinions of the system's critics, in whose view, the only benefit was held by the trust board-members who would now be able to award their own pay increases, balanced against the down-side of having to administer a more costly system of regulation; these two combining to increase the total drain on the NHS coffers. It remains to be seen if this way of lessening of State interference brings about any benefits which offset these greater costs of salaries and regulation.^[7]

See also

• Health care in Canada
• History of the National Health Service
• Publicly funded health care
• Universal health care
• National Health Service
• List of NHS Trusts
• Category:NHS Foundation Trusts

Further reading

• Pollock, Allyson; Colin Leys (2005-09-21). NHS plc : the privatisation of our health care. Verso Books. pp. 75–295. ISBN 978-1844675395. 

References

1. ^ Members Area - NHS
2. ^ South London & Maudsley NHS Trust. Our bold vision. Accessed 2007-09-16
3. ^ ^{a b} Monitor: Independent Regulator of NHS Foundation Trusts Public Register of NHS Foundation Trusts. Accessed 2008-05-19
4. ^ "Milburn unveils hospital franchise plan". London: The Guardian. 2002-01-15. http://www.guardian.co.uk/politics/2002/jan/15/publicservices.uk2. Retrieved 2008-05-19. 
5. ^ World Health Organisation, 16 September 2007, The World health statistics
6. ^ Brettingham, Madeleine (2005). "Local control over foundation trusts is "rhetoric"". British Medical Journal 330 (7505): 1408. doi:10.1136/bmj.330.7505.1408-d. http://www.bmj.com/cgi/content/full/330/7505/1408-d. Retrieved 2007-09-16. 
7. ^ Goddard, Maria; Verzulli, Rossella; Jacobs, Rowena (July 2011) Do Hospitals Respond to Greater Autonomy? Evidence from the English NHS. Centre for Health Economics, University of York, UK. Accessed 2011-07-21

Patricia Day and Rudolf Klein Governance of Foundation Trusts The Nuffield Trust 2005

External links

• Foundation Trust Network
• Monitor

• Department of Health information on NHS Foundation Trusts
• Independent Regulator of NHS Foundation Trusts (official site)
• Public register of NHS Foundation Trusts
• Unison (January 2007 Revised edition). In the Interests of Patients? The impact of the creation of a commercial market in the provision of NHS Care. Accessed 2007-09-15
• Allyson Pollock (2007-09-24) The Guardian: What Sicko doesn't tell you... Accessed 2007-09-25

• Official text of the Health and Social Care (Community Health and Standards) Act 2003 (c. 43) as amended and in force today within the United Kingdom, from the UK Statute Law Database
• Official text of the Health and Social Care (Community Health and Standards) Act 2003 (c. 43) as originally enacted within the United Kingdom, from the UK Statute Law Database