→History: ce, cameron-clegg
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{{short description|Semi-autonomous organisational unit within the National Health Service in England}} |
{{short description|Semi-autonomous organisational unit within the National Health Service in England}} |
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{{See also|NHS Wales#NHS trusts|label 1=NHS Wales trusts|NHS Scotland#Health boards|label 2=NHS Scotland health boards|Health and Social Care in Northern Ireland#Trusts|label 3=HSC Northern Ireland trusts}} |
{{See also|NHS Wales#NHS trusts|label 1=NHS Wales trusts|NHS Scotland#Health boards|label 2=NHS Scotland health boards|Health and Social Care in Northern Ireland#Trusts|label 3=HSC Northern Ireland trusts}} |
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{{Distinguish|NHS trust}} |
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⚫ | An '''NHS foundation trust''' is a semi-autonomous organisational unit within the [[National Health Service (England)|National Health Service]] in [[England]]. They have a degree of independence from the [[Department of Health and Social Care]] (and, until the abolition of SHAs in 2013, their local [[strategic health authority]]). As of March 2019 there were 151 foundation trusts. |
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==Inspiration== |
==Inspiration== |
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[[Alan Milburn]]'s trip in 2001 to the [[Hospital Universitario Fundación Alcorcón]] in Spain is thought to have been influential in developing ideas around foundation status. That hospital was built by the [[Spanish National Health System]], but its operational management is [[Outsourcing|contracted out]] to a private company, and exempt from many of the rules normally imposed on state-owned hospitals, and in particular, that hospital was allowed to negotiate its own contracts with workers. The governance of that hospital includes local government, trade unions, health workers and community groups.<ref>{{cite news|title=Milburn seeks hospital role model in Spain|url=https://www.theguardian.com/politics/2001/nov/06/uk.publicservices| |
[[Alan Milburn]]'s trip in 2001 to the [[Hospital Universitario Fundación Alcorcón]] in Spain is thought to have been influential in developing ideas around foundation status. That hospital was built by the [[Spanish National Health System]], but its operational management is [[Outsourcing|contracted out]] to a private company, and exempt from many of the rules normally imposed on state-owned hospitals, and in particular, that hospital was allowed to negotiate its own contracts with workers. The governance of that hospital includes local government, trade unions, health workers and community groups.<ref>{{cite news|title=Milburn seeks hospital role model in Spain|url=https://www.theguardian.com/politics/2001/nov/06/uk.publicservices|access-date=17 November 2014|work=The Guardian|date=6 November 2001}}</ref> |
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==History== |
==History== |
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Foundation trusts were announced by [[Secretary of State for Health|Health Secretary]] [[Alan Milburn]] in 2002,<ref name="announcement=guardian">{{Cite news|url=https://www.theguardian.com/politics/2002/jan/15/publicservices.uk2| |
Foundation trusts were announced by [[Secretary of State for Health|Health Secretary]] [[Alan Milburn]] in 2002,<ref name="announcement=guardian">{{Cite news|url=https://www.theguardian.com/politics/2002/jan/15/publicservices.uk2|access-date=19 May 2008|work=[[The Guardian]]|title=Milburn unveils hospital franchise plan| location=London| date=15 January 2002}}</ref> and the legislative basis was the [[Health and Social Care (Community Health and Standards) Act 2003]]. The first ten NHS hospitals to become foundation trusts were announced in 2004.<ref>{{cite news|title=Q&A: foundation hospitals|url=https://www.theguardian.com/society/2004/mar/31/nhs2000.medicineandhealth|access-date=9 November 2013|newspaper=Guardian|date=31 March 2004}}</ref> [[Gordon Brown]] prevented plans by [[Alan Milburn]] that they should be financially autonomous in 2002.<ref name="Who Runs Britain">{{cite book|last1=Peston|first1=Robert|title=Who Runs Britain?|date=September 2008|publisher=Hodder & Stoughton|location=London|isbn=9780340839447|page=[https://archive.org/details/whorunsbritain0000pest/page/247 247]|url=https://archive.org/details/whorunsbritain0000pest/page/247}}</ref> By 2012, the [[Monitor (NHS)|Monitor]] website listed 145 foundation trusts.<ref name=":0">{{Cite web|last=|first=|date=|title=NHS foundation trust directory|url=http://www.monitor-nhsft.gov.uk/home/about-nhs-foundation-trusts/nhs-foundation-trust-directory|url-status=dead|archive-url=https://web.archive.org/web/20120206002305/http://www.monitor-nhsft.gov.uk/home/about-nhs-foundation-trusts/nhs-foundation-trust-directory|archive-date=6 February 2012|website=Monitor|via=Internet Archive}}</ref> |
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Successive governments |
Successive governments set target dates by which all [[NHS trust]]s were supposed to have reached foundation status. For example, by 2009 the Department of Health was promoting "A new typeofNHS hospital".<ref name="shortguide">{{cite book |title=A Short Guide to NHS Foundation Trusts |publisher=Department of Health |url=https://www.nuffieldtrust.org.uk/files/2019-11/foundation.pdf |quote=1.10 The Government's aimisthat by 2008, all NHS Trusts will have reached a standard which would enable them to apply for NHS Foundation Trust status. This will ensure that throughout the country there are high performing organisations which are empoweredtodeliver high quality services to local people, so that no part of the NHS is left behind.|archive-url=https://web.archive.org/web/20200923091318/https://www.nuffieldtrust.org.uk/files/2019-11/foundation.pdf|archive-date=23 September 2020}}</ref> In 2011, the 116 trusts then in the pipeline to make applications were required to sign a formal agreement, with a deadline for the applicationtobe made. Board members at a number of trusts which missed the deadline were sacked.<ref>{{cite news|title=FT pipeline delays threaten boards with the sack|url=http://www.hsj.co.uk/acute-care/exclusive-ft-pipeline-delays-threaten-boards-with-the-sack/5042058.article#.UnbW4vlT6UM|access-date=3 November 2013|newspaper=Health Service Journal|date=1 March 2012}}</ref> |
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It was accepted by [[Andrew Lansley]] that a number of trusts would never reach foundation trust status, and a new organisation – the [[NHS Trust Development Authority]] – was established by the [[Health and Social Care Act 2012]] to supervise trusts which have not reached foundation status, of which there were 99 in April 2013, 47 of which were never expected to reach foundation status.<ref>{{cite news|title=NHS Trust Development Authority|url=http://www.hsj.co.uk/hsj-local/local-briefing/analysed-the-state-of-the-ft-pipeline/5056557.article#.UnbY3PlT6UM|access-date=3 November 2013|newspaper=Health Service Journal|date=25 March 2013}}</ref> |
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The [[Health and Social Care Bill 2011]], |
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⚫ | The [[Health and Social Care Bill 2011]], overseenbyLansley, proposed that all NHS trusts become foundation trusts or part of an existing foundation trust by April 2014. |
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The early foundation trusts were generally financially buoyant, but during 2013 and 2014 more faced financial difficulties. A foundation trust finance facility, managed by an advisory committee to the Department of Health, |
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⚫ | The early foundation trusts were generally financially buoyant, but during 2013 and 2014 more faced financial difficulties. A foundation trust finance facility, managed by an advisory committee to the Department of Health, was establishedtoprocess loans for capital developments, but during 2014 applications were made by trusts which had trouble paying utility bills or replacing medical equipment. Guidance issued under the tenure of [[Jeremy Hunt]] in October 2014 said that conditions could be set which could include: reductions in the use of temporary staff, "use of collaborative procurement routes" or "the adoption of a shared services solution".<ref>{{cite news|title=DH sets new bailout conditions for foundation trusts|url=http://www.hsj.co.uk/news/finance/dh-sets-new-bailout-conditions-for-foundation-trusts/5075976.article#.VGpsPfmsUk4|access-date=17 November 2014|date=21 October 2014}}</ref> By the end of 2013–14, foundation trusts collectively had built up cash reserves of £4.3 billion and it was suggested in the NHS [[Five Year Forward View]] that the government would "support" foundation trusts to spend this money "to help local service transformation". In response, the chief executive of the Foundation Trust Network, Chris Hopson, said: "The responsibility for these surpluses lies with the FTs; any attempt by the statutory bodies to make a grab for them will be furiously resisted".<ref>{{cite news|title=FTs will resist forced expenditure on primary care|url=http://www.hsj.co.uk/news/finance/fts-will-resist-forced-expenditure-on-primary-care/5076652.article#.VGxhM_msUk4|access-date=19 November 2014|date=13 November 2014}}</ref> |
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By 2016 the distinction between foundation trusts and other NHS trusts was widely regarded as eroded |
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⚫ | By 2016, the distinction between foundation trusts and other NHS trusts was widely regarded as eroded, and in that year the two regulators were combined into a new body, [[NHS Improvement]]. The notion that every trust should become a foundation trust was abandoned, and the widespread financial crisis undermined the supposed autonomy when almost all had to rely on money borrowed from the Department of Health, to which strings were attached.<ref>{{cite news|last1=Collins|first1=Ben|title=The foundation trust model: death by a thousand cuts|url=http://www.kingsfund.org.uk/blog/2016/02/foundation-trust-model|access-date=28 June 2016|publisher=Kings Fund|date=15 February 2016}}</ref> |
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==Function== |
==Function== |
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Foundation trusts have some managerial and financial freedom when compared to [[NHS trust]]s. The introduction of foundation trusts represented a change in the [[history of the National Health Service]] and the way in which hospital services are managed and provided. At the time of introduction they were described "as a sort of halfway house between the public and private sectors".<ref>{{cite news| url=https://www.theguardian.com/society/2002/nov/13/health.theissuesexplained | location=London | work=The Guardian | first1=Patrick | last1=Butler | first2=Simon | last2=Parker | title=Q&A: foundation trusts | date=14 November 2002}}</ref> This form of NHS trust is an important part of the United Kingdom government's programme to create a "patient-led" NHS with an [[NHS internal market|internal market]]. The 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. But after [[Gordon Brown]] prevented plans by [[Alan Milburn]] to make them financially autonomous<ref name="Who Runs Britain"/> they have been much more in the public sector and less autonomous than was originally expected. |
Foundation trusts have some managerial and financial freedom when compared to [[NHS trust]]s. The introduction of foundation trusts represented a change in the [[history of the National Health Service]] and the way in which hospital services are managed and provided. At the time of introduction, they were described "as a sort of halfway house between the public and private sectors".<ref>{{cite news| url=https://www.theguardian.com/society/2002/nov/13/health.theissuesexplained | location=London | work=The Guardian | first1=Patrick | last1=Butler | first2=Simon | last2=Parker | title=Q&A: foundation trusts | date=14 November 2002}}</ref> This form of NHS trust is an important part of the United Kingdom government's programme to create a "patient-led" NHS with an [[NHS internal market|internal market]]. The 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. But after [[Gordon Brown]] prevented plans by [[Alan Milburn]] to make them financially autonomous<ref name="Who Runs Britain"/> they have been much more in the public sector and less autonomous than was originally expected.{{Clarify|date=August 2023|reason=reliably-sourced explanation needed}} |
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== Statistics == |
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==Mutuality and governance== |
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By March 2013 there were 145 foundation trusts, of which 41 were mental health trusts and three were ambulance trusts.<ref name=":0" /> They included acute trusts, mental health, community and ambulance trusts.<ref name="monitor-register">Monitor: Independent Regulator of NHS Foundation Trusts [http://www.monitor-nhsft.gov.uk/register.php Public Register of NHS Foundation Trusts]. Accessed 19 May 2008</ref> By March 2019, the number of foundation trusts had shown a small increase to 151.<ref>{{Cite web|last=|first=|date=31 March 2019|title=Performance of the NHS provider sector|url=https://improvement.nhs.uk/documents/5404/Performance_of_the_NHS_provider_sector_for_the_quarter_4_1819.pdf|url-status=dead|archive-url=https://web.archive.org/web/20190617101821/https://improvement.nhs.uk/documents/5404/Performance_of_the_NHS_provider_sector_for_the_quarter_4_1819.pdf|archive-date=17 June 2019|website=NHS Improvement|via=Internet Archive}}</ref> |
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==Governance== |
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Each foundation trust has a council of governors. This is made up of elected governors and appointed governors.<ref name="duties">{{cite book |title=Your duties: a brief guide for NHS foundation trust governors |date=March 2014 |publisher=www.monitor.gov.uk |url=https://www.bcpft.nhs.uk/documents/about-us/assembly-of-governors/2105-brief-guide-for-governors/file}}</ref> Elected governors are chosen by a secret postal ballot of the membership, which is open to the general public.<ref name=bfw/> The elections are usually held in separate constituencies.<ref name=duties/> Typically there is a staff constituency, a patient constituency, and a "public member" constituency, consisting of members who are neither patients nor staff but live in a defined geographical area.<ref name=duties/> In addition, there are governors appointed by bodies with whom the trust works in partnership.{{ |
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The basic governance structure and form of foundation trusts is described in Schedule 7 of the [[National Health Service Act 2006]], with the formal corporate form being called a "public benefit corporation".<ref name="NHS Act 2006 Sch7">{{Cite legislation UK |type=act |year=2006 |chapter=41 |act=National Health Service Act 2006 |schedule=7 |date=8 November 2006 |accessdate=20 September 2022}}</ref> |
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⚫ | Each foundation trust has a council of governors. This is made up of elected governors and appointed governors.<ref name="duties">{{cite book |title=Your duties: a brief guide for NHS foundation trust governors |date=March 2014 |publisher=www.monitor.gov.uk |url=https://www.bcpft.nhs.uk/documents/about-us/assembly-of-governors/2105-brief-guide-for-governors/file}}</ref> Elected governors are chosen by a secret postal ballot of the membership, which is open to the general public.<ref name=bfw/> The elections are usually held in separate constituencies.<ref name=duties/> Typically there is a staff constituency, a patient constituency, and a "public member" constituency, consisting of members who are neither patients nor staff but live in a defined geographical area.<ref name=duties/> In addition, there are governors appointed by bodies with whom the trust works in partnership.{{citation needed|date=December 2020}} So, for example, appointments may be made by local councils, local medical schools, and local voluntary organisations.{{citation needed|date=December 2020}} Governors are intended to act as a link between the community and the board of directors.<ref name=bfw>[http://www.bfwhospitals.nhs.uk/members/ Members Area – NHS]</ref> The size of the council of governors and its exact composition are determined by the constitution of the particular trust. Each trust adopts its own constitution subject to certain restrictions in legislation.<ref name=duties/> These restrictions include that a majority of the council of governors must be elected governors and governors must be unpaid volunteers.{{citation needed|date=December 2020}} Some trusts are more committed to co-operative principles and have even written the [[Rochdale Principles]] into their constitution; they aspire to work closely and in partnership with other mutual and local organisations.<ref>South London & Maudsley NHS Trust. [http://www.slam.nhs.uk/about/foundation/Our%20Bold%20Vision.pdf Our bold vision]. Accessed 16 September 2007</ref> |
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By March 2013 there were 145 foundation trusts, of which 41 were mental health trusts and five were ambulance trusts. They are authorised and regulated by [[Monitor (NHS)|Monitor]], the independent regulator of foundation trusts. They include acute trusts, mental health, community and ambulance trusts. A full list of foundation trusts can be found on Monitor's website.<ref name="monitor-register">Monitor: Independent Regulator of NHS Foundation Trusts [http://www.monitor-nhsft.gov.uk/register.php Public Register of NHS Foundation Trusts]. Accessed 19 May 2008</ref> 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.{{cn}} |
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At first, foundation trusts were authorised and regulated by [[Monitor (NHS)|Monitor]], a non-executive body under the Department of Health. Monitor was merged into [[NHS Improvement]] in 2016.<ref>{{Cite web|last=Clover|first=Ben|date=27 October 2015|title=KPMG wins £1m contract to design NHS Improvement|url=https://www.hsj.co.uk/home/updated-kpmg-wins-1m-contract-to-design-nhs-improvement/5091477.article|url-access=registration|access-date=28 December 2021|website=Health Service Journal}}</ref> |
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The trade body for foundation trusts is [[NHS Providers]], formerly known as the Foundation Trust Network, which has 95% of all acute, ambulance, community and mental health foundation trusts in its membership. |
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⚫ | The trade body for foundation trusts is [[NHS Providers]], formerly known as the Foundation Trust Network, which has 95% of all acute, ambulance, community and mental health foundation trusts in its membership. |
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== Equivalent foundation trusts (eFT) == |
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Formerly referred to as ''foundation trust equivalent'' (FTe), this designation applies only to trusts providing high secure psychiatric services, of which there are three: [[Nottinghamshire Healthcare NHS Trust]], [[West London Mental Health NHS Trust]] and [[Mersey Care NHS Trust]]. |
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⚫ | A 2014 report by the [[Socialist Health Association]] said that on the whole after 10 years, "Foundation Trusts [had]... not deepened in terms of democratic practice and participation".<ref>{{cite news|last=Mayo|first=Ed|date=25 January 2014|title=Ten Years After – NHS Foundation Trusts|newspaper=Socialist Health Association|url=http://www.sochealth.co.uk/2014/01/25/20372/|access-date=16 March 2014}}</ref> |
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⚫ | These trusts abide by the Department of Health definition of a foundation trust, but the Secretary of State for Health maintains a direct line of communication and accountability with them because he or she 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. |
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The independence of Foundation Trust governors was challenged in 2021 when the governors of [[Queen Victoria Hospital]], a small specialist trust, called for a pause to plans for it to merge with [[University Hospitals Sussex NHS Foundation Trust]]. NHS Improvement were said to have effectively ordered the council of governors to work towards a merger.<ref>{{cite news |title=NHS England orders trust's governors to work towards controversial merger |url=https://www.hsj.co.uk/queen-victoria-hospital-nhs-foundation-trust/nhs-england-orders-trusts-governors-to-work-towards-controversial-merger/7031255.article? |access-date=27 December 2021 |publisher=Health Service Journal |date=4 November 2021}}</ref> |
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Unlike full foundation trusts, governors have no statutory role, and 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 trust, and cannot appoint or remove trust auditors. The chair and directors are not appointed by their board of governors |
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==Reception== |
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A study undertaken in 2005 by the [[King's Fund]] of [[Homerton University Hospital|Homerton University Hospital NHS Foundation Trust]] found some governors disappointed and disillusioned.{{citation needed|date=December 2020}} |
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⚫ | Another report in 2005, funded by the [[Nuffield Foundation]], 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.<ref>{{Cite journal | last =Brettingham | first = Madeleine| title =Local control over foundation trusts is "rhetoric" | journal =British Medical Journal | year =2005 | url= | doi =10.1136/bmj.330.7505.1408-d | pmc = 558406 | volume =330 | pages =1408 | issue=7505}}</ref> |
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⚫ | The public's perception of foundation trust status implying a high standard of clinical care was changed by the [[Mid Staffordshire NHS Foundation Trust]] scandal of the late 2000s ([[Stafford Hospital scandal|Stafford Hospital Scandal]]) and the ensuing [[Stafford Hospital scandal#Public inquiry|Francis inquiry]], published in 2013. At the outset, some critics claimed that foundation trusts went against the spirit of the principles laid out by [[Aneurin Bevan]], the founder of the NHS. Others feared that it would lead to a two-tier system. Others doubted whether foundation trust members would succeed in having any effective influence over hospital management.{{citation needed|date=December 2020}} |
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⚫ | In 2011, some argued in a report financed by the Nuffield Foundation that the success associated with foundation trusts had been due to other factors than governance.<ref>Goddard, Maria; Verzulli, Rossella; Jacobs, Rowena (July 2011) [http://www.york.ac.uk/media/che/documents/papers/researchpapers/RP64_Foundation_Trusts.pdf Do Hospitals Respond to Greater Autonomy? Evidence from the English NHS]. Centre for Health Economics, University of York, UK. Accessed 21 July 2011</ref> |
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⚫ | In June 2014, Bill Moyes, former [[Monitor (NHS)|Monitor]] executive chair, urged the NHS to reconsider "whether the model of foundation trusts is sensible", arguing "If one-third of the hospital system is permanently not demonstrating good viability and good governance, is that telling you something about actually how the system should run as opposed to how we thought it should run?".<ref>{{cite news|title=Bill Moyes questions whether FT model remains 'sensible'|url=http://www.hsj.co.uk/topics/foundation-trusts/bill-moyes-questions-whether-ft-model-remains-sensible/5071945.article#.U8PwnvldUk4|access-date=14 July 2014|publisher=Health Service Journal|date=16 June 2014}}</ref> |
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In January 2022 [[Sajid Javid]], writing in [[The Times]] said he was planning a “revolution” that would allow “well-run hospitals more freedom”.<ref>{{cite news |title=The Primer: Back to the foundations |url=https://www.hsj.co.uk/daily-insight/the-primer-back-to-the-foundations/7031754.article |access-date=20 March 2022 |publisher=Health Service Journal |date=24 January 2022}}</ref> |
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==Comparison with other NHS trusts== |
==Comparison with other NHS trusts== |
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Foundation trusts had a cap on the proportion of their income that can come from non-NHS treatments. It did not only apply to income derived from individual patients, it covered income from all non-NHS sources. This could include joint ventures to develop medical technologies, employers paying for counselling services or income from treating UK military personnel overseas. |
Foundation trusts had a cap on the proportion of their income that can come from non-NHS treatments. It did not only apply to income derived from individual patients, it covered income from all non-NHS sources. This could include joint ventures to develop medical technologies, employers paying for counselling services or income from treating UK military personnel overseas. |
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The Health and Social Care Act 2012 abolished the private patient income cap but FTs have to do the majority of their work for the NHS. This restriction was kept to reassure those concerned about future developments that FTs would continue to have NHS work as their central concern. Previously each FT had 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 had a cap of 1.5% or less. Until 2010 all mental health trusts were completely barred from undertaking non-NHS work, but after lobbying from the Foundation Trust Network it was raised to 1.5%. These caps disappeared on 1 October 2012. Collective earnings from private patients increased 14%, from £346.1 million in 2012–13 to £395.9 million for 2014–15. Private earning is concentrated on specialist hospitals in London who see many patients from other countries. Most trusts have negligible private income.<ref>{{cite news|title=NHS private pay income up 14% in two years|url=http://www.healthinvestor.co.uk/ShowArticle.aspx?ID=4259| |
The Health and Social Care Act 2012 abolished the private patient income cap but FTs have to do the majority of their work for the NHS. This restriction was kept to reassure those concerned about future developments that FTs would continue to have NHS work as their central concern. Previously each FT had 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 had a cap of 1.5% or less. Until 2010 all mental health trusts were completely barred from undertaking non-NHS work, but after lobbying from the Foundation Trust Network it was raised to 1.5%. These caps disappeared on 1 October 2012. Collective earnings from private patients increased 14%, from £346.1 million in 2012–13 to £395.9 million for 2014–15. Private earning is concentrated on specialist hospitals in London who see many patients from other countries. Most trusts have negligible private income.<ref>{{cite news|title=NHS private pay income up 14% in two years|url=http://www.healthinvestor.co.uk/ShowArticle.aspx?ID=4259|access-date=22 August 2015|publisher=Health Investor|date=3 August 2015}}</ref> |
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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. They also have to produce annual Quality Accounts. |
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==Achieving foundation trust status== |
==Achieving foundation trust status== |
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In order to achieve foundation trust status, NHS trusts have to pass a variety of tests, which have changed over time. In 2003 only trusts with three stars from the [[Commission for Health Improvement]] were eligible for foundation status. In that year Aintree Hospitals, Essex Rivers Healthcare, Newcastle upon Tyne Hospitals and Walsall Hospitals were all downgraded to two stars and so did not make the first wave of foundation trusts.<ref>{{cite news|title=Foundation hopefuls lose out|url=http://news.bbc.co.uk/1/hi/health/3068203.stm| |
In order to achieve foundation trust status, NHS trusts have to pass a variety of tests, which have changed over time. In 2003 only trusts with three stars from the [[Commission for Health Improvement]] were eligible for foundation status. In that year Aintree Hospitals, Essex Rivers Healthcare, Newcastle upon Tyne Hospitals and Walsall Hospitals were all downgraded to two stars and so did not make the first wave of foundation trusts.<ref>{{cite news|title=Foundation hopefuls lose out|url=http://news.bbc.co.uk/1/hi/health/3068203.stm|access-date=16 March 2014|newspaper=BBC News|date=16 July 2003}}</ref> |
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==Reservations and criticism== |
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The public's perception of |
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== Highly secure psychiatric services (EFT) == |
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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.<ref>{{Cite journal | last =Brettingham | first = Madeleine| title =Local control over foundation trusts is "rhetoric" | journal =British Medical Journal | year =2005 | url |
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⚫ | Formerly referred to as ''foundation trust equivalent'' (FTe) instead of ''Equivalent Foundation Trusts'', this designation applies only to trusts providing high secure psychiatric services, of which there are three: [[Nottinghamshire Healthcare NHS Trust]], [[West London Mental Health NHS Trust]] and [[Mersey Care NHS Trust]]. |
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⚫ | These trusts abide by the Department of Health definition of a foundation trust, but the Secretary of State for Health maintains a direct line of communication and accountability with them because he or she has the responsibility to provide healthcare to patients who have been detained under the [[Mental Health Act]],{{which|date=July 2023}} and have been judged to pose a grave and immediate danger to the public. |
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In June 2014 Bill Moyes, former Monitor executive chair, urged the NHS to reconsider "whether the model of foundation trusts is sensible", arguing "If one-third of the hospital system is permanently not demonstrating good viability and good governance, is that telling you something about actually how the system should run as opposed to how we thought it should run? |
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⚫ | Unlike full foundation trusts, governors have no statutory role, and 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 trust, and cannot appoint or remove trust auditors. The chair and directors are not appointed by their board of governors. |
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==See also== |
==See also== |
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* [[History of the National Health Service]] |
* [[History of the National Health Service]] |
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* [[List of NHS |
* [[List of NHS trusts in England]] |
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* [[ |
* [[:Category:NHS foundation trusts]] |
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* [[:Category:NHS Foundation Trusts]] |
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==Further reading== |
==Further reading== |
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==External links== |
==External links== |
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* [http://www.foundationtrustnetwork.org Foundation Trust Network] |
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* [http://www.monitor-nhsft.gov.uk Monitor] |
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* [http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/SecondaryCare/NHSFoundationTrust/fs/en Department of Health information on foundation trusts] |
* [http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/SecondaryCare/NHSFoundationTrust/fs/en Department of Health information on foundation trusts] |
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* [http://www.monitor-nhsft.gov.uk/register.php Public register of NHS Foundation Trusts] |
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* Unison (January 2007 Revised edition). [http://www.unison.org.uk/acrobat/16299.pdf In the Interests of Patients? The impact of the creation of a commercial market in the provision of NHS Care]. Accessed 2007-09-15 |
* Unison (January 2007 Revised edition). [http://www.unison.org.uk/acrobat/16299.pdf In the Interests of Patients? The impact of the creation of a commercial market in the provision of NHS Care]. Accessed 2007-09-15 |
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* Allyson Pollock (2007-09-24) The Guardian: [https://www.theguardian.com/g2/story/0,,2175622,00.html What Sicko doesn't tell you...] Accessed 2007-09-25 |
* Allyson Pollock (2007-09-24) The Guardian: [https://www.theguardian.com/g2/story/0,,2175622,00.html What Sicko doesn't tell you...] Accessed 2007-09-25 |
AnNHS foundation trust is a semi-autonomous organisational unit within the National Health ServiceinEngland. They have a degree of independence from the Department of Health and Social Care (and, until the abolition of SHAs in 2013, their local strategic health authority). As of March 2019 there were 151 foundation trusts.
Alan Milburn's trip in 2001 to the Hospital Universitario Fundación Alcorcón in Spain is thought to have been influential in developing ideas around foundation status. That hospital was built by the Spanish National Health System, but its operational management is contracted out to a private company, and exempt from many of the rules normally imposed on state-owned hospitals, and in particular, that hospital was allowed to negotiate its own contracts with workers. The governance of that hospital includes local government, trade unions, health workers and community groups.[1]
Foundation trusts were announced by Health Secretary Alan Milburn in 2002,[2] and the legislative basis was the Health and Social Care (Community Health and Standards) Act 2003. The first ten NHS hospitals to become foundation trusts were announced in 2004.[3] Gordon Brown prevented plans by Alan Milburn that they should be financially autonomous in 2002.[4] By 2012, the Monitor website listed 145 foundation trusts.[5]
Successive governments set target dates by which all NHS trusts were supposed to have reached foundation status. For example, by 2009 the Department of Health was promoting "A new type of NHS hospital".[6] In 2011, the 116 trusts then in the pipeline to make applications were required to sign a formal agreement, with a deadline for the application to be made. Board members at a number of trusts which missed the deadline were sacked.[7]
It was accepted by Andrew Lansley that a number of trusts would never reach foundation trust status, and a new organisation – the NHS Trust Development Authority – was established by the Health and Social Care Act 2012 to supervise trusts which have not reached foundation status, of which there were 99 in April 2013, 47 of which were never expected to reach foundation status.[8]
The Health and Social Care Bill 2011, overseen by Lansley, proposed that all NHS trusts become foundation trusts or part of an existing foundation trust by April 2014.
The early foundation trusts were generally financially buoyant, but during 2013 and 2014 more faced financial difficulties. A foundation trust finance facility, managed by an advisory committee to the Department of Health, was established to process loans for capital developments, but during 2014 applications were made by trusts which had trouble paying utility bills or replacing medical equipment. Guidance issued under the tenure of Jeremy Hunt in October 2014 said that conditions could be set which could include: reductions in the use of temporary staff, "use of collaborative procurement routes" or "the adoption of a shared services solution".[9] By the end of 2013–14, foundation trusts collectively had built up cash reserves of £4.3 billion and it was suggested in the NHS Five Year Forward View that the government would "support" foundation trusts to spend this money "to help local service transformation". In response, the chief executive of the Foundation Trust Network, Chris Hopson, said: "The responsibility for these surpluses lies with the FTs; any attempt by the statutory bodies to make a grab for them will be furiously resisted".[10]
By 2016, the distinction between foundation trusts and other NHS trusts was widely regarded as eroded, and in that year the two regulators were combined into a new body, NHS Improvement. The notion that every trust should become a foundation trust was abandoned, and the widespread financial crisis undermined the supposed autonomy when almost all had to rely on money borrowed from the Department of Health, to which strings were attached.[11]
Foundation trusts have some managerial and financial freedom when compared to NHS trusts. The introduction of foundation trusts represented a change in the history of the National Health Service and the way in which hospital services are managed and provided. At the time of introduction, they were described "as a sort of halfway house between the public and private sectors".[12] This form of NHS trust is an important part of the United Kingdom government's programme to create a "patient-led" NHS with an internal market. The 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. But after Gordon Brown prevented plans by Alan Milburn to make them financially autonomous[4] they have been much more in the public sector and less autonomous than was originally expected.[clarification needed]
By March 2013 there were 145 foundation trusts, of which 41 were mental health trusts and three were ambulance trusts.[5] They included acute trusts, mental health, community and ambulance trusts.[13] By March 2019, the number of foundation trusts had shown a small increase to 151.[14]
The basic governance structure and form of foundation trusts is described in Schedule 7 of the National Health Service Act 2006, with the formal corporate form being called a "public benefit corporation".[15]
Each foundation trust has a council of governors. This is made up of elected governors and appointed governors.[16] Elected governors are chosen by a secret postal ballot of the membership, which is open to the general public.[17] The elections are usually held in separate constituencies.[16] Typically there is a staff constituency, a patient constituency, and a "public member" constituency, consisting of members who are neither patients nor staff but live in a defined geographical area.[16] In addition, there are governors appointed by bodies with whom the trust works in partnership.[citation needed] So, for example, appointments may be made by local councils, local medical schools, and local voluntary organisations.[citation needed] Governors are intended to act as a link between the community and the board of directors.[17] The size of the council of governors and its exact composition are determined by the constitution of the particular trust. Each trust adopts its own constitution subject to certain restrictions in legislation.[16] These restrictions include that a majority of the council of governors must be elected governors and governors must be unpaid volunteers.[citation needed] Some trusts are more committed to co-operative principles and have even written the Rochdale Principles into their constitution; they aspire to work closely and in partnership with other mutual and local organisations.[18]
At first, foundation trusts were authorised and regulated by Monitor, a non-executive body under the Department of Health. Monitor was merged into NHS Improvement in 2016.[19]
The trade body for foundation trusts is NHS Providers, formerly known as the Foundation Trust Network, which has 95% of all acute, ambulance, community and mental health foundation trusts in its membership.
A 2014 report by the Socialist Health Association said that on the whole after 10 years, "Foundation Trusts [had]... not deepened in terms of democratic practice and participation".[20]
The independence of Foundation Trust governors was challenged in 2021 when the governors of Queen Victoria Hospital, a small specialist trust, called for a pause to plans for it to merge with University Hospitals Sussex NHS Foundation Trust. NHS Improvement were said to have effectively ordered the council of governors to work towards a merger.[21]
A study undertaken in 2005 by the King's FundofHomerton University Hospital NHS Foundation Trust found some governors disappointed and disillusioned.[citation needed]
Another report in 2005, funded by the Nuffield Foundation, 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.[22]
The public's perception of foundation trust status implying a high standard of clinical care was changed by the Mid Staffordshire NHS Foundation Trust scandal of the late 2000s (Stafford Hospital Scandal) and the ensuing Francis inquiry, published in 2013. At the outset, some critics claimed that foundation trusts went against the spirit of the principles laid out by Aneurin Bevan, the founder of the NHS. Others feared that it would lead to a two-tier system. Others doubted whether foundation trust members would succeed in having any effective influence over hospital management.[citation needed]
In 2011, some argued in a report financed by the Nuffield Foundation that the success associated with foundation trusts had been due to other factors than governance.[23]
In June 2014, Bill Moyes, former Monitor executive chair, urged the NHS to reconsider "whether the model of foundation trusts is sensible", arguing "If one-third of the hospital system is permanently not demonstrating good viability and good governance, is that telling you something about actually how the system should run as opposed to how we thought it should run?".[24]
In January 2022 Sajid Javid, writing in The Times said he was planning a “revolution” that would allow “well-run hospitals more freedom”.[25]
Foundation trusts had a cap on the proportion of their income that can come from non-NHS treatments. It did not only apply to income derived from individual patients, it covered income from all non-NHS sources. This could include joint ventures to develop medical technologies, employers paying for counselling services or income from treating UK military personnel overseas.
The Health and Social Care Act 2012 abolished the private patient income cap but FTs have to do the majority of their work for the NHS. This restriction was kept to reassure those concerned about future developments that FTs would continue to have NHS work as their central concern. Previously each FT had 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 had a cap of 1.5% or less. Until 2010 all mental health trusts were completely barred from undertaking non-NHS work, but after lobbying from the Foundation Trust Network it was raised to 1.5%. These caps disappeared on 1 October 2012. Collective earnings from private patients increased 14%, from £346.1 million in 2012–13 to £395.9 million for 2014–15. Private earning is concentrated on specialist hospitals in London who see many patients from other countries. Most trusts have negligible private income.[26]
In order to achieve foundation trust status, NHS trusts have to pass a variety of tests, which have changed over time. In 2003 only trusts with three stars from the Commission for Health Improvement were eligible for foundation status. In that year Aintree Hospitals, Essex Rivers Healthcare, Newcastle upon Tyne Hospitals and Walsall Hospitals were all downgraded to two stars and so did not make the first wave of foundation trusts.[27]
Formerly referred to as foundation trust equivalent (FTe) instead of Equivalent Foundation Trusts, this designation applies only to trusts providing high secure psychiatric services, of which there are three: Nottinghamshire Healthcare NHS Trust, West London Mental Health NHS Trust and Mersey Care NHS Trust.
These trusts abide by the Department of Health definition of a foundation trust, but the Secretary of State for Health maintains a direct line of communication and accountability with them because he or she has the responsibility to provide healthcare to patients who have been detained under the Mental Health Act,[which?] and have been judged to pose a grave and immediate danger to the public.
Unlike full foundation trusts, governors have no statutory role, and 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 trust, and cannot appoint or remove trust auditors. The chair and directors are not appointed by their board of governors.
1.10 The Government's aim is that by 2008, all NHS Trusts will have reached a standard which would enable them to apply for NHS Foundation Trust status. This will ensure that throughout the country there are high performing organisations which are empowered to deliver high quality services to local people, so that no part of the NHS is left behind.