A foundation trust is a semi-autonomous organisational unit within the
National Health Service
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
in
England
England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe b ...
. They have a degree of independence from the
Department of Health and Social Care
The Department of Health and Social Care (DHSC) is a department of His Majesty's Government responsible for government policy on health and adult social care matters in England, along with a few elements of the same matters which are not otherwis ...
(and, until the abolition of SHAs in 2013, their local
strategic health authority
Strategic health authorities (SHA) were part of the structure of the National Health Service in England between 2002 and 2013. Each SHA was responsible for managing performance, enacting directives and implementing health policy as required by the ...
). As of March 2019 there were 151 foundation trusts.
Inspiration
Alan Milburn
Alan Milburn (born 27 January 1958) is a British Labour Party politician who was Member of Parliament (MP) for Darlington from 1992 to 2010. He served for five years in the Cabinet, first as Chief Secretary to the Treasury from 1998 to 1999, a ...
's trip in 2001 to the
Hospital Universitario Fundación Alcorcón
The Hospital Universitario Fundación Alcorcón (HUFA) is a major general hospital in Alcorcón, a city in the Madrid metropolitan area of Spain. It was founded in 1997.
Although the hospital was built by the Spanish National Health System, its m ...
in Spain is thought to have been influential in developing ideas around foundation status. That hospital was built by the
Spanish National Health System
The Spanish National Health System ( es, Sistema Nacional de Salud, SNS) is the agglomeration of public healthcare services that has existed in Spain since it was established through and structured by the ''Ley General de Sanidad'' (the "Health G ...
, 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.
History
Foundation trusts were announced by
Health Secretary Alan Milburn
Alan Milburn (born 27 January 1958) is a British Labour Party politician who was Member of Parliament (MP) for Darlington from 1992 to 2010. He served for five years in the Cabinet, first as Chief Secretary to the Treasury from 1998 to 1999, a ...
in 2002,
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.
Gordon Brown
James Gordon Brown (born 20 February 1951) is a British former politician who served as Prime Minister of the United Kingdom and Leader of the Labour Party (UK), Leader of the Labour Party from 2007 to 2010. He previously served as Chance ...
prevented plans by
Alan Milburn
Alan Milburn (born 27 January 1958) is a British Labour Party politician who was Member of Parliament (MP) for Darlington from 1992 to 2010. He served for five years in the Cabinet, first as Chief Secretary to the Treasury from 1998 to 1999, a ...
that they should be financially autonomous in 2002.
By 2012, the
Monitor
Monitor or monitor may refer to:
Places
* Monitor, Alberta
* Monitor, Indiana, town in the United States
* Monitor, Kentucky
* Monitor, Oregon, unincorporated community in the United States
* Monitor, Washington
* Monitor, Logan County, West ...
website listed 145 foundation trusts.
Successive governments set target dates by which all
NHS trust
An NHS trust is an organisational unit within the National Health Services of England and Wales, generally serving either a geographical area or a specialised function (such as an ambulance service). In any particular location there may be several ...
s were supposed to have reached foundation status. For example, by 2009 the Department of Health was promoting "A new type of NHS hospital".
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.
It was accepted by
Andrew Lansley
Andrew David Lansley, Baron Lansley, (born 11 December 1956) is a British Conservative Party (UK), Conservative politician who previously served as Secretary of State for Health and Social Care, Secretary of State for Health and Leader of the H ...
that a number of trusts would never reach foundation trust status, and a new organisation – the
NHS Trust Development Authority
The NHS Trust Development Authority (NHSTDA) was an executive non-departmental public body of the Department of Health. Its formation came as a result of reorganisation of the National Health Service (NHS) in England outlined in the Health and Soci ...
– was established by the
Health and Social Care Act 2012
The Health and Social Care Act 2012c 7 is an act of the Parliament of the United Kingdom. It provided for the most extensive reorganisation of the structure of the National Health Service in England to date.''BMJ'', 2011; 342:d408Dr Lansley's Mon ...
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.
The
Health and Social Care Bill 2011
The Health and Social Care Act 2012c 7 is an act of the Parliament of the United Kingdom. It provided for the most extensive reorganisation of the structure of the National Health Service in England to date.'' BMJ'', 2011; 342:d408Dr Lansley's M ...
, 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
Jeremy Richard Streynsham Hunt (born 1 November 1966) is a British politician who has served as Chancellor of the Exchequer since 14 October 2022. He previously served in the Cabinet as Secretary of State for Culture, Olympics, Media and Sport ...
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". 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
The Five Year Forward View was produced by NHS England in October 2014 under the leadership of Simon Stevens as a planning document.
Publication and reception
It received praise for brevity, being only 39 pages, and lacking the illustrations wh ...
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".
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
NHS Improvement (NHSI) was a non-departmental body in England, responsible for overseeing the National Health Service's foundation trusts and NHS trusts, as well as independent providers that provide NHS-funded care. It supported providers to ...
. 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.
Function
Foundation trusts have some managerial and financial freedom when compared to
NHS trust
An NHS trust is an organisational unit within the National Health Services of England and Wales, generally serving either a geographical area or a specialised function (such as an ambulance service). In any particular location there may be several ...
s. The introduction of foundation trusts represented a change in the
history of the National Health Service
The name National Health Service (NHS) is used to refer to the free public health services of England, Scotland and Wales, individually or collectively. Northern Ireland’s services are known as 'Health and Social Care' to promote its dual integ ...
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". 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
James Gordon Brown (born 20 February 1951) is a British former politician who served as Prime Minister of the United Kingdom and Leader of the Labour Party (UK), Leader of the Labour Party from 2007 to 2010. He previously served as Chance ...
prevented plans by
Alan Milburn
Alan Milburn (born 27 January 1958) is a British Labour Party politician who was Member of Parliament (MP) for Darlington from 1992 to 2010. He served for five years in the Cabinet, first as Chief Secretary to the Treasury from 1998 to 1999, a ...
to make them financially autonomous
they have been much more in the public sector and less autonomous than was originally expected.
Statistics
By March 2013 there were 145 foundation trusts, of which 41 were mental health trusts and three were ambulance trusts.
They included acute trusts, mental health, community and ambulance trusts.
[Monitor: Independent Regulator of NHS Foundation Trust]
Public Register of NHS Foundation Trusts
Accessed 19 May 2008 By March 2019, the number of foundation trusts had shown a small increase to 151.
Governance
The basic governance structure and form of foundation trusts is described in Schedule 7 of the
National Health Service Act 2006
The National Health Service Act 2006c 41 is an Act of the Parliament of the United Kingdom. It sets out the structure of the National Health Service in England.
It was altered and completely renumbered by the Health and Social Care Act 2012c ...
, with the formal corporate form being called a "public benefit corporation".
Each foundation trust has a council of governors. This is made up of elected governors and appointed governors.
Elected governors are chosen by a secret postal ballot of the membership, which is open to the general public.
[ The elections are usually held in separate constituencies.][ 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.][ In addition, there are governors appointed by bodies with whom the trust works in partnership. So, for example, appointments may be made by local councils, local medical schools, and local voluntary organisations. Governors are intended to act as a link between the community and the board of directors.][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.[ These restrictions include that a majority of the council of governors must be elected governors and governors must be unpaid volunteers. Some trusts are more committed to co-operative principles and have even written the ]Rochdale Principles
The Rochdale Principles are a set of ideals for the operation of cooperatives. They were first set out in 1844 by the Rochdale Society of Equitable Pioneers in Rochdale, England and have formed the basis for the principles on which co-operativ ...
into their constitution; they aspire to work closely and in partnership with other mutual and local organisations.
At first, foundation trusts were authorised and regulated by Monitor
Monitor or monitor may refer to:
Places
* Monitor, Alberta
* Monitor, Indiana, town in the United States
* Monitor, Kentucky
* Monitor, Oregon, unincorporated community in the United States
* Monitor, Washington
* Monitor, Logan County, West ...
, a non-executive body under the Department of Health. Monitor was merged into NHS Improvement
NHS Improvement (NHSI) was a non-departmental body in England, responsible for overseeing the National Health Service's foundation trusts and NHS trusts, as well as independent providers that provide NHS-funded care. It supported providers to ...
in 2016.
The trade body for foundation trusts is NHS Providers
NHS Providers is the membership organisation for NHS trusts in England, which takes part in negotiations between the trusts and the Department of Health and provides development support to trust leaders. Until 2011, it was a section of the NHS Con ...
, 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
The Socialist Health Association (SHA, called the Socialist Medical Association before May 1981) is a socialist medical association based in the United Kingdom. It is affiliated to the Labour Party as a socialist society.
History
The Social ...
said that on the whole after 10 years, "Foundation Trusts ad.. not deepened in terms of democratic practice and participation".
The independence of Foundation Trust governors was challenged in 2021 when the governors of Queen Victoria Hospital
The Queen Victoria Hospital (QVH), located in East Grinstead, West Sussex, England is the specialist reconstructive surgery centre for the south east of England, and also provides services at clinics across the region. It has become world-fam ...
, a small specialist trust, called for a pause to plans for it to merge with University Hospitals Sussex NHS Foundation Trust
University Hospitals Sussex NHS Foundation Trust is an NHS foundation trust which provides clinical services to people in Brighton and Hove, East Sussex, parts of East Sussex and West Sussex. It is abbreviated as UHSx to avoid confusion with Un ...
. NHS Improvement were said to have effectively ordered the council of governors to work towards a merger.
Reception
A study undertaken in 2005 by the King's Fund
The King's Fund is an independent think tank, which is involved with work relating to the health system in England. It organises conferences and other events.
Since 1997, they have jointly funded a yearly award system with GlaxoSmithKline. Th ...
of Homerton University Hospital NHS Foundation Trust
Homerton Healthcare NHS Foundation Trust is an NHS foundation trust based in London, England, which runs Homerton University Hospital.
History
The trust was established as Homerton Hospital NHS Trust on 24 December 1994, and became operatio ...
found some governors disappointed and disillusioned.
Another report in 2005, funded by the Nuffield Foundation
The Nuffield Foundation is a charitable trust established in 1943 by William Morris, Lord Nuffield, the founder of Morris Motors Ltd. It aims to improve social well-being by funding research and innovation projects in education and social pol ...
, 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.
The public's perception of foundation trust status implying a high standard of clinical care was changed by the Mid Staffordshire NHS Foundation Trust
The Mid Staffordshire NHS Foundation Trust was a NHS foundation trust which managed two hospitals in Staffordshire, England:
* Stafford Hospital - acute hospital with approximately 350 inpatient beds, opened in 1983, Now renamed County Hospita ...
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
Aneurin "Nye" Bevan PC (; 15 November 1897 – 6 July 1960) was a Welsh Labour Party politician, noted for tenure as Minister of Health in Clement Attlee's government in which he spearheaded the creation of the British National Health ...
, 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.
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.
In June 2014, Bill Moyes, former Monitor
Monitor or monitor may refer to:
Places
* Monitor, Alberta
* Monitor, Indiana, town in the United States
* Monitor, Kentucky
* Monitor, Oregon, unincorporated community in the United States
* Monitor, Washington
* Monitor, Logan County, West ...
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?".
In January 2022 Sajid Javid
Sajid Javid (; born 5 December 1969) is a British politician who served as Secretary of State for Health and Social Care from June 2021 to July 2022, having previously served as Home Secretary from 2018 to 2019 and Chancellor of the Exchequer f ...
, writing in The Times
''The Times'' is a British daily national newspaper based in London. It began in 1785 under the title ''The Daily Universal Register'', adopting its current name on 1 January 1788. ''The Times'' and its sister paper ''The Sunday Times'' (fou ...
said he was planning a “revolution” that would allow “well-run hospitals more freedom”.
Comparison with other NHS trusts
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.
Achieving foundation trust status
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
The Commission for Health Improvement (CHI) was a non-departmental public body sponsored by the Department of Health of the United Kingdom from 2001 until 2004, when its functions were subsumed by the Healthcare Commission.
CHI was established by ...
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.
Highly secure psychiatric services (EFT)
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
Nottinghamshire Healthcare NHS Foundation Trust, based in Nottinghamshire, England, manages the UK’s largest and most integrated Forensic High Secure facility Rampton Hospital near Retford (which covers specialist services such as the High Se ...
, 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
Mental Health Act is a stock short title used for legislation relating to mental health law.
List Canada
* Mental Health Act (Ontario) (Ontario)
India
*The Mental Health Care Act, 2017
Ireland
*The Mental Health Act 2001
New Zealand
*The Men ...
, 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.
See also
* History of the National Health Service
The name National Health Service (NHS) is used to refer to the free public health services of England, Scotland and Wales, individually or collectively. Northern Ireland’s services are known as 'Health and Social Care' to promote its dual integ ...
* List of NHS Trusts in England
* :NHS Foundation Trusts
Further reading
*
*
References
External links
Foundation Trust Network
Monitor
Department of Health information on foundation trusts
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
Accessed 2007-09-25
*
{{DEFAULTSORT:Nhs Foundation Trust
Co-operatives in the United Kingdom