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1. 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.
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2. Why has Addenbrooke’s NHS Trust applied to become a NHS Foundation Trust?
All NHS Trusts will eventually have the chance to become NHS Foundation Trusts.
Addenbrooke’s NHS Trust was given the opportunity to apply to become one of the first-wave trusts because at the time it was a three-star trust. Because all trusts are likely to become NHS Foundation Trusts, it was felt that it was beneficial to the Trust to apply for the first wave and, therefore, have a say in the shaping of NHS Foundation Trusts. We also believed that there would 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;
For staff: the opportunity to become a member of the NHS Foundation Trust and elect staff members to the board of governors;
For local partner organisations: the opportunity to sit on the board of governors and help develop local services that are co-ordinated and responsive to patient needs;
For Addenbrooke’s: the opportunity to:
Involve the patients, public and staff in the running of the organisation;
Develop a wider range of services, known as unregulated services;
Raise capital money without going through current NHS approvals processes;
Retain financial surpluses made during a financial year.
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3. 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 will be 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.
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4. 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.
1. All NHS Trusts should eventually have the opportunity to become NHS Foundation Trusts. The government has announced £200 million extra funding to ensure that all trusts raise their standards to three-star status and are, therefore, eligible to apply to become a NHS Foundation Trust.
2. 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.
3. 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 Addenbrooke’s 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.
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5. 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.
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6. Does it mean the Trust will be privatised?
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.
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7. 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 board of governors. They have an absolute majority. The board 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.
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8. Why did we need to do this now? Why couldn't we have waited until NHS Foundation Trusts are more established so we knew what the benefits and pitfalls are?
As an organisation, we have always strived to be at the forefront of developments and have considered the benefits that NHS Foundation Trust status could bring for local people and staff. One of these is that as part of the first wave of NHS Foundation Trusts, the Trust has the opportunity to help shape the way these Trusts are developed.
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9. Will the change to NHS Foundation Trust status be permanent? Would we need to reapply after a few years? Would it change if we had a change of government?
Becoming an NHS Foundation Trust involves a legal change to our organisational status. We will not need to reapply. Any changes to our status in the future would involve a legal change in that status. Therefore, it is not likely to change with a new government.
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10. 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.
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11. How are NHS Foundation Trusts regulated if we don't have to answer to a strategic health authority and Whitehall?
NHS Foundation Trusts are accountable to the local community through a board of governors and a board of directors. We are also accountable to a local patient's forum and to health care commissioners who fund the NHS services provided at Addenbrooke's.
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12. What were the most important/significant changes to your application/plan for the NHS Foundation Trust following the consultation?
The number of staff governors was increased from three to four.
The number of public and patient governors was therefore increased from 14 to 15 to retain their majority, as required by the legislation. Two separate categories for patient (and carer) and public governors were made.
Cambridgeshire and Peterborough Mental Health Partnership NHS Trust was included as a co-opted governor.
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13. What are the key changes to the Health and Social Care Bill that were made following its discussion in November 2003, ie at about the same time as the consultation period?
The key changes made to the legislation at this time (and our responses) were:
The requirement for applicant NHS trusts to separate the public and patient constituencies.
We adopted this as required by the legislation.
The opportunity for the NHS trust to agree an opt-out qualification for the staff of the NHS Foundation Trust (ie staff would automatically become members unless they opted out).
We chose to adopt this because many of our staff had questioned why they were not automatically members.
The opportunity for the NHS trust to automatically include all patients who had been treated by the hospitals in the past three years as members (with an opt-out provision).
We chose NOT to adopt this, partly for practical reasons (contacting large numbers of people). Any patient or carer can opt in to becoming one of our patient members - we don't ask when, or for how long, you have received services. If you also live in the membership area, you can choose to become a public member instead.
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14. As one of the first NHS Foundation Trusts, we are more likely to make mistakes from which others following us might learn. Will this be reflected in an increased amount of support (or flexibility) in the first stages of being an NHS Foundation Trust?
We are indeed doing many things for the first time in establishing the NHS Foundation Trust. For example we set up a process for the election of governors, which no NHS trust has done before.
We received help and guidance from the Department of Health, and from the Electoral Reform Ballot Service Limited, which is an expert in this field. We are, therefore, receiving support that will help to minimise any mistakes we make, but it is still possible that we will make some.
The Department of Health were very supportive in the process of writing the application and preparing for NHS Foundation Trust status. Now we are successful in our application to become an NHS Foundation Trust, we will work with Monitor to make the new organisation a success. We expect that the regulator and his team will also be supportive.
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