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Foundation Trusts

Foundation Trusts. Helen Dickinson. Few caveats. RCPath available worldwide-so don’t just focus on UK policy LTHT just begun application process We are one of the largest NHS trusts in the UK with around 14,500 staff and a budget of nearly £800 million.”. Why?.

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Foundation Trusts

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  1. Foundation Trusts Helen Dickinson

  2. Few caveats • RCPath available worldwide-so don’t just focus on UK policy • LTHT just begun application process • We are one of the largest NHS trusts in the UK with around 14,500 staff and a budget of nearly £800 million.”

  3. Why? • A health service employing over a million people in hundreds of locations nationwide cannot be run from Whitehall…. • …need NHS hospitals led by local communities and by NHS professionals delivering services on the ground.

  4. What is a Foundation Trust • Co-operative/mutual organisation for public benefit • Part of NHS –must meet national healthcare standards • Based on need, not ability to pay

  5. Government Policy • First NHS Foundation Trusts established in 2004 • All Trusts must have applied for Foundation status by 2010 • Local control-able to respond to needs of local community • More flexibility how resources are used • Greater opportunities to get investment

  6. key points • Decentralisation of public services & creation of patient led NHS • Part of NHS -provide NHS care to NHS patients. Subject to NHS standards, performance ratings & systems of inspection • Public benefit corporations-greater local ownership rather than DoH control

  7. Key points • Democratic -elect Governers to work with Board of Directors. • Boards role to manage hospitals-set budgets,pay & other operational matters • Governers role to hold them to account • Not privatisation -must use assets to provide NHS services not to make profits or distribute them -legal block to de-mutualisation

  8. Key points • Not for profit • Not elitism-all Trusts expected to apply • Better focus on needs of community

  9. How does they work • Trusts recruit Members (patient/carer/staff/public) to plan future • Council of Governers (elected or appointed) to represent Members and work with Board of Directors • LTH proposes 35 Governers + Chair • Staff Governers • Public Governers (majority)

  10. Who can become members? • All staff (LTHT opt-out) • Local people served by hospital • Patients • Carers • Don’t receive special treatment

  11. What is role of members? • Members • All members should receive regular info and be consulted on plans for future development • Elect Governers • Stand as Governers • Give community views to and from Governers • Give opinions on future direction, proposals for change

  12. Governers • Some flexibility but every board must have • A chair • Majority elected by public • At least 1 gov representing local PCTs • At least 1 gov representing local authorities • At least 3 gov representing staff • At least 1 gov from local Uni (if includes medical/dental school

  13. Council of Governers • Appoint Chair and non-exec directors • Decide remuneration, allowances & terms of office of Chair and non-exec directors • Appoint auditors • Receive annual report and accounts • Guide strategic direction and plans • Hold Board of Directors to account

  14. Board of Directors • Operationally manage the Trust, finance, services stc • Set strategy plans & budget • Accept liability • Assess risk • Measure progress • Account to Council of Governers

  15. Accountability • Clear accountability framework- • Accountable locally through Council of Governers • Accountable to Commissioners including PCTs – legally binding agreements for delivery of NHS services • Monitor-Independent Regulator of NHS Foundation trusts-oversees and monitors against terms of authorisation-powers to intervene

  16. Terms of authorisation • Must operate to national standards and targets • Major changes to services must be agreed by Monitor • Limit on borrowings • Limit on % private work (same level as 2002-2003) • Must provide essential ‘protected’ NHS goods & services

  17. New freedoms • Free from central Government control, no longer performance managed by Health Authorities ?? • Financial freedoms- • can borrow money from private sector • Can retain financial surpluses –from efficiency savings or disposing of assets (estates)to invest in new/improving services • Can purchase from any supplier • Can develop new solutions to long standing problems eg staff shortages, waiting lists

  18. Finance • Historically-negotiating skills • From April 2005—PbR-services delivered according to tariff. Foundation trusts were early adopters (April 2004) • Cuts lengthy price negotiations, PCTs can choose alternative providers

  19. FT finance • Greater freedoms • Build up operational surpluses • Retain proceeds from asset sales • More freedom to borrow –linked to ability to repay (Prudential Code)

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