NHS Foundation Trust
Encyclopedia
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, .
s. 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. 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.
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..
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.
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.
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.
Alan Milburn
in 2002. By April 2011, the Monitor website listed 137 Foundation Trusts.
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.
(who founded the NHS). Others feared that it would lead to a two-tier system. 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.
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. This study was funded by the Nuffield Foundation
.
:Category:NHS Foundation Trusts
National Health Service (England)
The National Health Service or NHS is the publicly funded healthcare system in England. It is both the largest and oldest single-payer healthcare system in the world. It is able to function in the way that it does because it is primarily funded through the general taxation system, similar to how...
in England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
and has gained a degree of independence from the Department of Health
Department of Health (United Kingdom)
The Department of Health is a department of the United Kingdom government with responsibility for government policy for health and social care matters and for the National Health Service in England along with a few elements of the same matters which are not otherwise devolved to the Scottish,...
and local NHS strategic health authority
NHS Strategic Health Authority
NHS strategic health authorities are part of the structure of the National Health Service in England. Each SHA is responsible for enacting the directives and implementing fiscal policy as dictated by the Department of Health at a regional level. In turn each SHA area contains various NHS trusts...
.
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 trustNHS Hospital Trust
An NHS hospital trust, also known as an acute trust is an NHS trust that provides secondary health services within the English National Health Service and in NHS Wales. Hospital trusts are commissioned to provide these services by NHS primary care trusts....
s. The introduction of NHS foundation trusts represented a change in the history of the National Health Service
History of the National Health Service
The name National Health Service is used to refer to the four public health services of England, Northern Ireland, Scotland and Wales, individually or collectively, though only England's NHS officially has this title...
and the way in which hospital services are managed and provided.
This form of NHS trust is an important part of the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
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. Some trusts are more committed to co-operative principles and have even written the Rochdale Principles
Rochdale Principles
The Rochdale Principles are a set of ideals for the operation of cooperatives. They were first set out by the Rochdale Society of Equitable Pioneers in Rochdale, England, in 1844, and have formed the basis for the principles on which co-operatives around the world operate to this day. The...
into their constitution and aspire to work closely and in partnership with other mutual as well as local organisations.
As of November 2011 there were 140 NHS foundation trusts. They are authorised and regulated by Monitor
Monitor (NHS)
Monitor, also known as the Independent Regulator for NHS Foundation Trusts, is a non-departmental public body in the United Kingdom. Its purpose is to regulate NHS Foundation Trusts or Foundation Hospitals - hospitals that have opted out of direct governmental control. The body was established in...
, 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..
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 SecretarySecretary of State for Health
Secretary of State for Health is a UK cabinet position responsible for the Department of Health.The first Boards of Health were created by Orders in Council dated 21 June, 14 November, and 21 November 1831. In 1848 a General Board of Health was created with the First Commissioner of Woods and...
Alan Milburn
Alan Milburn
Alan Milburn is a British Labour Party politician, who was the Member of Parliament for Darlington from 1992 until 2010...
in 2002. By April 2011, the Monitor website listed 137 Foundation Trusts.
The Health and Social Care Bill 2011
Health and Social Care Bill 2011
The Health and Social Care Bill 2011 is proposed health care reform legislation introduced in the House of Commons on 19 January 2011. If passed, the Bill would be the most extensive reorganisation of the structure of the National Health Service in England to date. It proposes to abolish NHS...
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 BevanAneurin Bevan
Aneurin "Nye" Bevan was a British Labour Party politician who was the Deputy Leader of the Labour Party from 1959 until his death in 1960. The son of a coal miner, Bevan was a lifelong champion of social justice and the rights of working people...
(who founded the NHS). Others feared that it would lead to a two-tier system. 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
King's Fund
The King's Fund is a charitable foundation in England. Founded as the Prince of Wales Hospital Fund for London in 1897, the fund changed its name in 1902 to King Edward's Hospital Fund after the accession to the throne of King Edward VII...
of Homerton University Hospital NHS Foundation Trust
Homerton University Hospital
Homerton University Hospital is an NHS-run University Hospital in Homerton, Hackney- East London.-Overview:The hospital is run by the Homerton University Hospital NHS Foundation Trust, which was established on 1 April 2004 and is one among the first ten foundation trusts established in England...
found some governors disappointed and disillusioned.
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. This study was funded by the Nuffield Foundation
Nuffield Foundation
The Nuffield Foundation is a British charitable trust, established in 1943 by William Morris , the founder of the Morris Motor Company. Lord Nuffield wanted to contribute to improvements in society, including the expansion of education and the alleviation of disadvantage...
.
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.See also
- Health care in CanadaHealth care in CanadaHealth care in Canada is delivered through a publicly-funded health care system, which is mostly free at the point of use and has most services provided by private entities. It is guided by the provisions of the Canada Health Act. The government assures the quality of care through federal standards...
- History of the National Health ServiceHistory of the National Health ServiceThe name National Health Service is used to refer to the four public health services of England, Northern Ireland, Scotland and Wales, individually or collectively, though only England's NHS officially has this title...
- Publicly funded health care
- Universal health careUniversal health careUniversal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
- National Health ServiceNational Health ServiceThe National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
- List of NHS Trusts
:Category:NHS Foundation Trusts
External links
- 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