FOUNDATION TRUSTS - Working for the local community?

On the Department of Health's Website, it explains it's version of what a Foundation Trust is, and how it will operate. Alternatively, THIS FAQ page OR THIS FAQ page from The Guardian perhaps gives a more rounded and objective idea. HERE you will find a list of the issues and seven good reasons, in the interests of patients and staff, as to why UNISON opposes Foundation Trusts.

Listed below are some of the claims made about Foundation Trusts, followed by articles which perhaps give a truer picture of these claims.

"Working within the local community, for the local community"

One would assume that the needs of those patients would include not being victims of diverted priorities which result from going for Foundation Hospital status. The fact is that there are currently 173 Acute Trusts within the NHS, out of which 87 are Foundation Trusts. That number represents only 50% of all Acute Trusts. Yet 90% of the worst 10 Trusts for Hospital Standardised Mortality Ratios (HSMR) are either Foundation Trusts, or applying for Foundation Trust Status, the only Trust out of the ten which wasn't a Foundation Trusts being Queen Mary's Sidcup which had however recently undergone a merger process with Bromley Hospitals and Queen Elizabeth Hospital (Woolwich) to form the South London Healthcare NHS Trust. And the frightening fact is that those ten Trusts have higher levels than Mid-Staffordshire NHS Foundation Trust, who allegedly left the collateral damage of the lives of up to 400 patients in it's wake as they strived to achieve Foundation status. The Trust which has the highest HSMR in the country, Basildon and Thurrock University Hospitals NHS Foundation Trust, proudly proclaims itself as "The Trust Where Patients Come First" without any visible sense of irony . There is strong evidence to suggest that priorities are diverted from patients when these huge organizational changes are happening.

The ten trusts whose mortality rates are now worse than Mid Staffordshire ­ based on the most recent annual data from Dr Foster are:

Basildon and Thurrock University Hospitals NHS Foundation Trust (132) (Foundation Trust)
Wrightington, Wigan and Leigh NHS Trust (126) (Foundation Trust)
Blackpool Fylde and Wyre Hospitals (123) (Foundation Trust)
George Eliot Hospital, Nuneaton (120) (Applying for Foundation Trust Status)
Swindon and Marlborough (120) (Foundation Trust)
North Middlesex University Hospital (119) (Foundation Trust)
Bolton Hospitals (118) (Foundation Trust)
Queen Mary’s Sidcup (117) (Involved in a merger on April 1st 2009).
Tameside Hospital (117) (Foundation Trust)
Mid Cheshire Hospitals (117) (Foundation Trust)

Since the data was prepared, Swindon and Marlborough has been renamed Great Western Hospitals NHS Foundation Trust and Bolton Hospital has been renamed Royal Bolton Hospital NHS Foundation Trust.

From The British Medical Journal: A new report has cast doubt on the government's claim that foundation trusts will prove more accountable to local communities. The year long study of Homerton University Hospital NHS Foundation Trust in east London by the health charity The King's Fund shows disillusionment among its governors.

The trust was one of the first to gain foundation status. Many of the governors complain that they have had little or no influence on how the hospital is run. Boards of governors, which consist mainly of members of the public, were supposed to be the watchdogs that gave local people a greater say in the running of foundation trusts.

But Richard Lewis, the report's author, said, "There's a sense among the governors that they have no idea what they're actually supposed to be doing.

"If governors have little real influence it will be hard to claim that foundation trusts represent a leap forward in public accountability."

One governor at the trust, quoted anonymously in the report, said: "I regret to say that I wouldn't be able to pinpoint a particular point or issue that I have been able to achieve by my being a governor."

Another governor, who is a staff member, said: "I am not aware of any decision that we've influenced."

" Democracy is at the heart of an NHS Foundation Trust "

One of the pledges to staff in the NHS Constitution is: "To engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working arrangements". Yet according to the recent Staff Survey, the NUH is the sixth worst Acute Trust (out of 170) in the country for it's current commitment to this pledge. With the financial crisis biting, the government cuts imposed, and the pressures on the Trust to balance the books to achieve Foundation Status taking effect, are we supposed to believe that the Trust is going to suddenly start prioritizing staff engagement, or that when staff (and patients) are 'members' of the Foundation Trust, that lack of commitment to staff engagement will magically change to full engagement of 'members', or is, as seems more likely, their lack of commitment to the engagement of staff going to deteriorate even further? Lack of engagement is actually the antithesis of democracy.  

Some Foundation Trusts are running elections that would be considered "disgraceful" if they took place in local government, according to a study funded by the Nuffield Trust. The report, written by Patricia Day, a senior research fellow, and Rudolf Klein, emeritus professor, at Bath University’s Centre for the Analysis of Social Policy, casts doubt on the government’s claim that foundation trusts hand power to local people and represent "a new form of social ownership."

The six month study examined government discussions before the policy was unveiled in December 2002. As well as information made available by the trusts themselves, the researchers found unsettling evidence of "governors not governing . . . and organisations which can hardly be said to be ’owned’ by local people." It says: "Political rhetoric needs to be tested against reality...in what respect, and how, are boards accountable to local people?"

The writers argue that governing boards are unrepresentative and excluded from the management process. High level decisions are taken by trust chairs and chief executives, who are unelected and unaccountable to the local population.

Less than a quarter of Foundation Trusts are holding their Board of Directors’ meetings in public, according to a Health Service Journal Poll. Only seven of 30 foundation trusts questioned allowed the public to attend even a small part of their Directors’ meetings. Only nine Trusts routinely published papers that went to their boards, only 11 published minutes of the sessions, and Foundations are not actually required to hold board meetings in public or publish minutes. The fact that Mid Staffordshire Foundation Trust’s Board “generally discussed matters in private” was highlighted by the Healthcare Commission report into failures of care at the Trust, and a Foundation Trust Network survey last August found 42 per cent had entirely closed Directors’ meetings.

That smells of something, and it’s not the sweet scent of democracy.

"Greater Financial Freedom"

What they seem to have forgot to put on their website, but Sir Gerry Robinson helpfully reminds us in an article in The Telegraph, is that it also gives them other financial freedoms. Freedoms which are soon to be investigated by the Health Select Committee, the fact that chief executives of NHS foundation trusts are paid on an average of £158,000. Across the board at executive level within the NHS, salaries rose by 7.6 per cent in foundation trusts, and only a miserly 5.7 per cent for executives in non-foundation bodies.

In an article in The Express:

Martin Yeates is the former Chief Executive at Mid Staffordshire NHS Foundation Trust. Mr Yeates was singled out for criticism after Mid Staffs was subjected to one of the most damning reports on NHS treatment. Yet documents show his pay band was £135,000-£140,000 in 2006-7. He got a rise even at the height of the Mid Staffs scandal in February 2008 when the trust achieved foundation status, and his pay went up to £180,000.

At Norfolk and Norwich Hospital NHS Foundation Trust Chief Executive Paul Forden got a rise of more than 150 per cent from £60,000-£65,000 to £165,000-£170,000 between 2004 and 2008. But between 2002 and 2006 the trust was ranked among the worst in the ­country for deaths from superbugs such as MRSA, with 65 fatalities.

Colchester Hospital University Foundation Trust gained foundation status last May despite failing to meet ­targets on reducing MRSA infection. Its chief executive of four years, Peter Murphy, enjoyed a salary of £135,000-£140,000. His predecessor earned £85,000-£90,000 in 2005.

Tony Spotswood chief executive of the Royal Bournemouth and Christchurch Hospitals Foundation Trust had a rise of 14 per cent last year, taking his pay to more than £160,000.

Julie Acred chief executive of Derby Hospitals NHS Foundation Trust had a rise of £10,000 last year, bringing her wages up to £180,000. She is entitled to nearly £1million on retirement.

Chief executive of Kettering General Hospital Foundation Trust Mark Newbold’s salary rose by 7.8 per cent to £152,000 with foundation status last November. A spokeswoman said that "this reflected the increased responsibilities of a trust".

There was debate and uncertainty at UNISON Health Conference this month as to whether Foundation Trusts may have the legal right to withdraw from the National Terms and Conditions provided by Agenda For Change, and impose their own local pay and conditions. In other words, there is a possibility that Foundation Trust Status could give executives, who award themselves an average of a 7.6% pay rise, the power to reduce your pay.

Ask yourself this question. Do you think that the decisions which are made presently are always made with integrity and guided in the interests of patients? Then ask yourself how much you think that situation will improve when we are a Foundation Trust.