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NHS Foundation Trust
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An NHS foundation trust is an NHS trust that 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.
Function
They 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 UK Government's programme to create a "patient-led" NHS.
Discussion
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Encyclopedia
An NHS foundation trust is an NHS trust that 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.
Function
They 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 UK Government's programme to create a "patient-led" NHS. Whilst 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, others however see the change towards semi-independent hospital boards as a move towards privatisation of the health service.
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. Some trusts are more committed to co-operative principles and have even written the Rochdale Principles into their constitution and aspire to work closely with other mutual organisations.
NHS foundation trusts are authorised and regulated by Monitor, the independent regulator of NHS foundation trusts. A full list of NHS foundation trusts can be found on their website.
Foundation Trust equivalent (FTe)
This designation can apply to those trusts only, which are providing high secure psychiatric services.
As the name suggests, these trusts abide by the same Department of Health definition for a Foundation Trust but with the important difference: the Secretary of State maintains a direct line of communication and accountability with them through their appropriate SHA. This requirement is needed because he has the responsibility to provided healthcare to 'patients' who have been detained, and have been judged, to pose a grave danger to the public (if at large).
Whilst the Secretary of State has the same clear view and ability to direct the prevision of services to this group of patients under the old system, under the new structures that are designed to give the appearance of a patient lead NHS, these special controls need to be added as extras, which results in a more complex and greater administrative burden.
Comparison with other hospitals
Unlike hospitals outside the NHS, Foundation Trusts have a cap on the proportion of their income that can come from non-NHS treatments, such as from fee-paying patients.
History
Foundation trusts were announced by Health Secretary Alan Milburn in 2002.
By May 2008, the Monitor website listed over 100 Foundation Trusts.
Criticisms
The introduction has not been without its critics. Some pointed out that Foundation Trusts go against the spirit of the principles laid out by Aneurin Bevan (who founded the NHS). Others said that it will lead to a two-tier system, as in Canada, and whilst the quality of healthcare in their system is excellent, the World Health Organisation has discovered it has the longest waiting times for any developed country. Worse, for those that can no longer afford private insurance, accessing it through the publicly funded side proves most difficult with many not succeeding.
Another doubt is about whether the Foundation Members will actually succeed in having any effective influence over the hospital management. History seems to have proven, that since the 1600s entry process into the higher echelons of medicine (and especially those of surgeons and physicians) has a counter tendency of selecting those -who are by nature- steadfastly resistant to accepting guidance and advice from outside their profession.
A further concern is that Foundation Trusts will quickly copy the USA and come to see some conditions as more profitable, and concentrate on those at the expense of others. The 2007 WHO report found that despite expenditure being almost double of the UK, the resulting outcomes were no better.
Also, there exists every possibility that individual Foundation Members can be misled to voting with the management due simply to their medical ignorance. For example: Lay people may be easily led to believe that spending money on a new scanner, then spending more money on using it for frequent screening for cancer will improve survival rates. However, all that happens is that earlier detection starts the clock ticking earlier. Therefore, whilst the clock runs for longer it is without the benefit of overall increases in real and absolute survival times - but it looks good in the performance tables. However, the expenditure on such high technology may well take money away from many more less spectacular, but more life-prolonging and more life-enhancing services in other healthcare areas.
A study undertaken by the King's Fund of Homerton University Hospital NHS Foundation Trust found the governors disappointed and disillusioned.
Another report found, was that it is too easy to invite members to sit on sub-committees, where they quickly become bogged down in the minutiae of operational planning, whilst the main decisions are taken at meetings that they only come to hear about after they have happened. This study was funded by the Nuffield Foundation and was echoed in British Medical Journal, as was The King's Fund findings.
The older existing NHS system was praised in 2007 by the documentary maker Michael Moore in his film Sicko.
See also
- Category:NHS Foundation Trusts
Further reading
External links
- Allyson Pollock (2007-09-24) The Guardian: Accessed 2007-09-25
- (2003 Chapter 43)
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- (official site)
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- Unison (January 2007 Revised edition). . Accessed 2007-09-15
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