HealthPolicyMonitor | Surveys| LSE - GB| 08| Latest Developments Regarding Foundation Trusts

Abstract
Characteristics of this policy
Purpose and process analysis
Expected outcome
References

Abstract

Details on the motivation behind, and organization of, Foundation Trusts can be viewed in reports in survey rounds 1(2003), 2(2003), and 5(2005). This current report summarises the latest developments in awarding Foundation Trust status to NHS hospitals, with the intention that the greater autonomy in service organisation and financial management that is consequent on gaining Foundation Trust status will motivate better service and accountability to local communities.

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Neue Entwicklungen

Suchhilfe

Characteristics of this policy

Innovationsgrad	traditionell	innovativ
Kontroversität	unumstritten	kontrovers
Strukturelle Wirkung	marginal	fundamental
Medienpräsenz	sehr gering	sehr hoch
Übertragbarkeit	sehr systemabhängig	systemneutral
current previous

My views are clear from the above, and from previous Health Policy Monitor reports on Foundation Trusts. I will, however, reserve final judgment until their merits and demerits become clearer.

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Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Stakeholder positions

The policy is now in full motion, and as far as I am aware there have not been major changes in stakeholder positions to the most recent developments. Those who believed that offering greater autonomy to hospitals would improve services and accountability continue to do so; those who were skeptical of this policy direction, and expressed concern that the creation of Foundation Trusts might lead to a two-tiered NHS, or that Central Government would be unable politically to offer much autonomy over local services in the current organisational structure of the health care system, continue to express these reservations.

Influences in policy making and legislation

There are no new legislative developments as far as I am aware. The policy passed through Parliament some years ago, and is now an ongoing policy direction.

Legislative outcome

Enactment

Adoption and implementation

In August 2006, the independent assessor of Foundation Trusts, Monitor, announced that they had authorised eight more hospitals for Foundation Trust status. Forty-eight hospitals are now Foundation Trusts; the eight new Foundation Trusts have a combined income of 1.24 billion pounds sterling, and the total forty-eight Foundation Trusts have a combined income of 9.48 billion pounds, more than 10% of the NHS budget.

Moreover, the Health Minister (Patricia Hewitt) stated that she would offer her support for twelve additional hospitals to apply for Foundation Trust status. These twelve hospitals will now undergo an authorization process undertaken by Monitor, and those hospitals that will be 'approved' will be announced in three batches, in November and December 2006, and February 2007.

Monitoring and evaluation

The Healthcare Commission undertook an analysis of existing Foundation Trusts in 2005, which is the latest information that is available on their 'merits'. The Healthcare Commission concluded that the Foundation Trusts had showed an increased ability to plan and develop new services, were relatively adept at gaining access to capital investment, were quicker at making decisions around improvements in services, had an increased level of public and patient involvement in their Boards, were relatively rigorous in managing their finances, had maintained their standards of care in terms of access and quality, and had sustained a positive relationship with the local commissioners (i.e. PCTs) of their services. Moreover, the Foundation Trusts were not found to have used unfair competition to attract staff from other local health care facilities, had not cream skimmed patients, have continued staff and training investment practices, and have continued to work in partnership with other local services.

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Expected outcome

To me, the analysis by the Healthcare Commission does not really offer a strong indication that the Foundation Trusts have offered substantive improvements in patient services, or indeed definitive improvements in accountability to local populations. The effects appear 'weak', and really seem to show that things do not seem to have gotten worse over the dimensions assessed, which is hardly a strong endorsement for introducing Foundation Trusts.
The extent to which a Central Government, accountable to the electorate for NHS funding, financing, provision and performance, can 'let go of' the management and organisation of hospitals, is also not clear to me. That said, it is really too early to assess the success or otherwise of Foundation Trusts. Hopefully, the benefits (or otherwise) that they offer will become clearer over the next few years.