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1. What benefits are there for patients?
Patients and members of the public can become members of the NHS Foundation Trust. They can stand for election to the board of governors and, therefore, be involved in influencing major decisions about the future of the hospital.
Local people who live within the membership area (see map of membership area) can register as either public or patient (if they have been patients or carers) members of the NHS Foundation Trust. They can stand for election to become a governor of the hospital. If they do not wish to stand themselves, then they can elect other people to the board of governors.
The Trust will be able to make more decisions locally to respond to the needs of the community and individual patients. We will also be able to build on our current good relationships with partner organisations (for example, the University of Cambridge) to examine how we can develop new services and technologies that might generate income to be invested back into NHS services.
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2. Will it change the service I get from my GP? Will I still be referred in the same way?
All general practitioners (GPs) in the local area will still be able to refer the patients they see to Addenbrooke’s. We hope that patients will chose to be treated at Addenbrooke’s because they will receive an excellent clinical service.
Over time, patients will be offered more choice about which treatment will address their particular need and where they would like to be treated. This might involve being offered a choice of hospitals where they can receive treatment. We hope that patients will choose to come to Addenbrooke’s.
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3. Will patients who are members be treated better?
No. Everyone who is referred to Addenbrooke's by a GP or consultant will be treated fairly. No preferential treatment will be given to patients, and the treatment of non-members will not be compromised.
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4. Will the Trust get extra money for being a NHS Foundation Trust?
Becoming an NHS Foundation Trust will not in itself provide any extra funding. If an NHS Foundation Trust is financially successful, though, it will be able to use the additional freedoms for the benefit of its patients.
NHS Foundation Trusts have freedom to develop new ways of working that reflect local needs and priorities, but within the NHS framework of standards and inspection to ensure quality and safety.
They are free to innovate in how they use their resources and retain surpluses to invest in developing new services.
They also have a wider range of options for capital funding so that new ideas can be brought to fruition more quickly.
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5. What financial freedoms will we have as a NHS Foundation Trust?
The financial freedoms given to NHS Foundation Trusts will apply to decisions about managing the existing assets of the organisation. They also allow access to a wide range of funding to both improve and expand services and support innovation.
They cover three key areas:
Retention of proceeds from the sale of assets;
Retention of operating surpluses to invest in developing new services;
Access to capital based on financial performance and ability to meet any liabilities incurred as a result of borrowing.
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6. Will there be more financial resources to recruit more staff?
Due to the 'payment by results' scheme, there is potential for extra revenue. The board of directors and the board of governors would then determine how to spend this. For example, this could be spent on staff or facilities.
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7. Are there any financial risks now we have become a NHS Foundation Trust and if so, what are they? (Can we go bankrupt?)
If an existing Trust is not financially viable, the ultimate responsibility would lie with the secretary of state and measures would be put in place to prevent it going bankrupt.
With NHS Foundation Trust status, the responsibility ultimately rests with the trust but will be closely monitored by Monitor (formerly the independent regulator). If things go wrong, there is a robust mechanism in place with clear powers of intervention. These powers would be applied according to the seriousness of the breach of licence and include:
Additional reporting requirements, following adverse reports from the Commission for Healthcare Audit and Inspection (CHAI);
Formal or informal warning letters issued to a NHS Foundation Trust;
Removal of some or all of the board of directors, or ordering new elections to the board of governors;
In extreme cases, they will have the power to recommend that the assets of a NHS Foundation Trust are transferred to another NHS body or merged with another NHS Foundation Trust, so protecting the services to patients.
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8. What will prevent a NHS Foundation Trust from stopping providing some services?
The licence issued to us by Monitor ensures continuity of services for NHS patients. This is particularly important where alternative provision of a particular service is limited.
NHS Foundation Trusts are obliged to offer certain services (known as regulated services). On establishment, these will replicate the clinical services provided to NHS patients at the time. Changes to the list of regulated services of a NHS Foundation Trust can only be made with the consent of Monitor.
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9. What contractual agreements will we have with primary care trusts and how will we be funded?
NHS Foundation Trusts will be fully responsible for the outcomes they achieve in terms of volume of work, quality and responsiveness to patients. Outputs of NHS Foundation Trusts must be negotiated and agreed with primary care trusts (PCTs) and then formalised into legally binding contracts. This differs from the present situation; currently, the trust does not hold legally binding contracts with PCTs because the strategic health authority (SHA) oversees the process.
PCTs control the majority of NHS resources, and they will use their three-year budgets to decide which services to commission from NHS Foundation Trusts. Therefore, the NHS Foundation Trusts will continue to be funded by PCTs.
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10. Will we be allowed to generate other sources of income?
Yes. Income could be generated from:
Primary care trusts, other NHS commissioners and/or other public-sector bodies;
The provision of other clinical services for individuals and bodies that are not part of the NHS;
Income from non-clinical services.
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11. How will NHS Foundation Trust status affect relationships with private finance initiative (PFI) partners?
NHS Foundation Trusts continue to be able to procure capital schemes using the PFI process, subject to the same degree of oversight as applies under the current arrangements. Suitable assurances will be given to sponsors of existing and future PFI schemes, in line with current best practice. This will prevent the new arrangements for NHS Foundation Trusts being regarded as an adverse change in law for existing deals.
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12. Why doesn't the government just give us more money/freedom anyway and leave us as we are?
We provide services to the public using public (that is, taxpayers') money. We have to be accountable for the way in which we spend that money. This policy is about changing the focus of that accountability away from Whitehall to the people who use and rely on these services. We think that is a change for the better, but we would not want greater freedom if it compromises our ability to be accountable to the public for the services we provide.
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13. What do you mean by 'payment by results', and how will this impact on us as an NHS Foundation Trust?
'Payment by results' is the new funding mechanism for hospitals in the NHS. There is a national price list covering all patient treatments. Hospitals will be funded by primary care trusts according to this national 'price list' as opposed to any locally agreed deals as now. This new initiative will be phased in over a period of time and will not be fully in place until 2008. This initiative will affect NHS Trusts and NHS Foundation Trusts in exactly the same way, except NHS Foundation Trusts will be allowed to phase it in more quickly.
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14. Can an NHS Foundation Trust keep any surplus it makes?
Yes. The NHS Foundation Trust can keep any surplus it makes, and this can be re-invested in NHS services. Investment must also comply with the NHS Foundation Trust financial regime.
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15. Does a NHS Foundation Trust receive any set-up funding?
Yes. £250,000 is given to the applicant NHS Trust by the Department of Health.
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16. How much money will NHS Foundation Trusts be allowed to borrow?
The borrowing limit will be individually agreed between each NHS Foundation Trust and Monitor. There will be a 'Prudential Borrowing Code', which will set out how the borrowing limit will be calculated. The borrowing limit will be based on the NHS Foundation Trust's ability to pay back any debt incurred.
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17. What changes will be visible after becoming an NHS Foundation Trust?
We are still known as Addenbrooke’s Hospital, but our Trust name hasl changed to Cambridge University Hospitals NHS Foundation Trust.
This new name is intended to communicate the many ‘faces’ of the Trust: clinical care, education, research and economic contribution. This is a combination of strengths that ultimately benefit the health and well-being of all the communities we serve.
Over time, with NHS Foundation Trust status, we hope that staff, the public and patients will feel even more involved in the decisions that the Trust takes.
We also hope that some of our new financial freedoms will help us further improve the facilities available to patients and staff around the hospital. These might even lead to the development of new facilities for patients such as a dedicated cancer centre or a children’s hospital.
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