Becoming a Foundation Trust – your questions answered
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What is an NHS Foundation Trust?
NHS Foundation Trusts are NHS trusts that are given freedom from the controls of government to develop services to suit the needs of their local community. NHS Foundation Trusts are accountable to local people through an elected board of governors. They continue to be fully part of the National Health Service (NHS) and provide services to patients on the basis of need and not ability to pay. Staff continue to be part of the NHS workforce and are entitled to be members of the NHS Pension Scheme.
Why is East and North Herts NHS Trust applying to become a NHS Foundation Trust?
All NHS Trusts are expected to have the chance to apply to become a NHS Foundation Trust by the end of 2010.
We believe that there will be benefits for patients, the public and staff. These benefits might be:
- For the public: the opportunity to be involved in the development of the hospital and elect public members to the Council of Governors
- For staff: the opportunity to become a member of the NHS Foundation Trust and elect staff members to the Council of Governors
- For local partner organisations: the opportunity to sit on the Council of Governors and help develop local services that are co-ordinated and responsive to patient needs
- For our community: the opportunity to
- Involve patients, public and staff in the running of the organisation
- Develop a wider range of services, known as unregulated service
- Raise capital money without going through current NHS approvals processes;
- Retain financial surpluses made during a financial year for investment in hospital services.
Does it mean we are opting out of the NHS?
No. NHS Foundation Trusts are still be part of the NHS ‘family’ and subject to NHS quality standards, performance targets and systems of inspection. They treat NHS patients but are controlled and run locally rather than nationally. There are safeguards to ensure they continue to provide NHS services. There is a legal lock on the assets of NHS Foundation Trusts so that they cannot be sold. They are also bound by a legal duty to work in co-operation with others, such as primary care trusts (PCTs), to improve the quality of healthcare throughout the NHS.
I’ve heard NHS Foundation Trusts will make it a ‘two-tier’ NHS? Is that right and what does it mean?
- Some people are concerned that the development of NHS Foundation Trust will mean that NHS staff and patients will gain more benefits in these trusts. There are a number of reasons why this is unlikely to be the case.All NHS Trusts should eventually have the opportunity to become NHS Foundation Trusts. The government has announced extra funding to ensure that all trusts raise their standards and are, therefore, eligible to apply to become a NHS Foundation Trust.
- NHS Foundation Trusts are required to adopt the new pay system known as Agenda for Change. Adopting the system will mean that staff across the NHS will be paid according to national pay spines.
- NHS Foundation Trusts will have a duty of co-operation laid down in the Health and Social Care Act. This will require trusts to co-operate with other NHS Trusts and build on their existing strong partnerships. This is an important principle for East and North Herts and we will continue to support our strong partnership with local NHS organisations.
For these and other reasons it is in the interests of all local health and social care organisations to work together to develop services for all our patients. We believe that all aspects of the local health system can benefit from any one hospital pursing NHS Foundation Trust status.
What differences will it make to the Trust? Why do we want to change?
NHS Foundation Trusts will be ‘owned’ by the local communities they serve. Having local people, patients and staff on the board of governors encourages the trust to concentrate more on the needs of its local communities when looking at how it will achieve government targets. NHS Foundation Trusts have more financial freedoms to develop their services in the way they want; for example retaining any surpluses at the end of a financial year or raising capital money outside the current lengthy NHS approval processes.
What does foundation trust status mean for a hospital?
Essentially it will mean that a hospital trust has greater local freedom or self-determination. It is governed by a partnership between the Board of Directors and the Council of Governors, representing patients, the public, staff and partners organisations.
Does it mean the Trust will be privatised?
No. The care NHS Foundation Trusts provide to NHS patients will continue to be delivered on the basis of need, not ability to pay, and will be free at the point of use.
NHS Foundation Trusts are legally required to use the assets they hold in ways that promote their primary purpose of providing NHS care to NHS patients. They are bound by a legal duty to work in co-operation with others to improve the quality of healthcare throughout the NHS.
How will local people become more involved in the running of the Trust?
NHS Foundation Trusts are democratic. Local people have the chance to become members and these members will elect their representatives to serve on the Council of Governors. They have an absolute majority. The Council of Governors holds the Board of Directors to account, electing the chair and non-executive members of the Board, and approving the appointment of the chief executive.
Who can become a member?
Essentially staff employed by the Trust plus patients and members of the public living within the areas we define as being our public constituencies.
Who can’t become a member?
There are likely to be very few exceptions, but – like most other foundation trusts – we do not plan to allow anyone who has been abusive to our staff to join.
What will I have to do if I become a member?
Membership will be tailored to reflect individual members’ interests and the amount of time they have available. For example some members may just wish to receive a regular newsletter, while others may wish to take part in surveys. Yet others may wish to join working groups or stand for election as a governor.
Do members receive expenses?
We will not usually pay member expenses however an expenses policy will be established once we are authorised.
What will governors do?
Governors act essentially as guardians of the foundation trust. Their responsibilities will include attending Council meetings to represent the views and interests of the communities that they represent, acting as a sounding board for and influencing and informing decisions taken by the Board of Directors. They also have responsibility for appointing the foundation trust chairman and non-executive directors and approving the appointment of the chief executive.
Who are governors elected by and how?
The majority of governors are elected by their constituencies – either public or staff. A minority of governors will be directly nominated by partner organisation to serve on the Council of Governors.
Will governors be paid?
No but they will receive reasonable travel expenses.
What’s the point of becoming a foundation trust – won’t this all be reversed after the next election?
Whilst changes of government will always influence the strategic direction of the NHS, it is likely that the majority of acute and mental health trusts will be foundation trusts by the next election – well over 100 trusts. We also know that that all the major parties broadly favour greater local involvement in NHS services. Foundation trusts, by their nature, have secured significant support for their existence from their local communities as represented by their membership.
What happens if NHS Foundation Trust status doesn’t work out?
Monitor (formerly called the independent regulator)’s role is to work alongside the Trust to make sure it does work. Where Monitor has serious concerns that an individual NHS Foundation Trust is in breach of its terms of authorisation, he or she will have statutory powers to intervene and take action to prevent problems in the future.
In the unlikely circumstance that the NHS Foundation Trust does not succeed, Monitor would work with the Trust to make sure that a new organisation is established to continue to provide health services. As is the case with NHS Trusts, if something goes seriously wrong it will be primarily the responsibility of the organisation itself to take appropriate remedial action and to prevent future problems by learning the lessons and sharing this information with others.
How are NHS Foundation Trusts regulated if we don’t have to answer to a strategic health authority and Whitehall?
The East and North Herts Foundation Trust will be accountable to the local community through a Council of Governors and a Board of Directors. We are also accountable to healthcare commissioners (e.g. Primary Care Trusts and Practice Based Commissioning Groups) who fund the NHS services provided at the Trust.
What is the benefit to patients and the public of becoming a foundation trust , why is change necessary?
What people want is clean, safe, hospitals, they don’t want or need to be involved in the process, why is another layer of bureaucracy being added?