Posts Tagged ‘Foundation trusts’

Trusts to lure patients for private treatment

By Francesca Robinson - 20th July 2010 8:45 am

Foundation trust hospitals will be able to take on an increasing amount of private work under new freedoms announced in the new white paper on health.

If the reforms are implemented the private patients income cap will be abolished, freeing foundation trusts to compete with the private sector for business.

The reforms will give foundation trusts scope to merge more easily and also to collaborate with private sector organisations.

The Foundation Trust Network has been lobbying for an end to the private patient income cap, set in 2002/03 to an average of 2% of revenue. This has restricted their ability to offer additional services and attract extra resources.

Health secretary Andrew Lansley told MPs that one of the best performing hospitals in Britain, the Royal Marsden, generated 25% of its income from private patients and this should be replicated across the country.

Sue Slipman, FTN director, said University College London Hospital was already providing their consultants with the opportunity to do private work. “Consultants benefit because they do not have to travel long distances to do their private work. The trust gains because their consultants on site if their NHS patients need them and helps them to attract high calibre doctors.”

Mental health trusts could offer talking therapies to business for their workforce health schemes. Liverpool Women’s Hospital was looking at a model to offer private fertility treatments, currently rationed by the NHS.

“Foundation trusts will play to their strengths. Some will provide the private treatment themselves, others will do the work in partnership with private sector providers and they earn money out of that,” she said.

Slipman said there would also be the opportunity for foundation trusts to exploit intellectual capital. “Clearly a lot of that is going to come from consultants and doctors - these reforms are incredibly motivating for everybody. It’s a way of saying now we can all get on with what we came in to the system to do. This very exciting.”

The government has said that all NHS trusts must become foundation trusts by 2013/14. Currently 130 of the 169 NHS trusts are foundation trusts.

But an analysis of the government’s proposals by Tribal, a private sector provider of public sector services, is pessimistic about the pace of growth of the private sector following the reforms.

“Over time the private sector will doubtless expand its currently tiny share of the market but organic growth will be comparatively slow. The major opportunity for the private sector would come if and when the current NHS incumbents fail to make the transition to the new regime. Under those circumstances government might well expect if not invite the private sector in.”

John Lister, director of the union-funded pressure group London Health Emergency, claimed the relaxation of the cap on private work was a step towards privatisation of the NHS. He complained that trusts might overstretch themselves in chasing private patients and could be driven by perverse incentives whereby they stood to make more money by getting patients into their private wings.

He also warned that doctors and other staff working for foundation trusts could also face the loss of national NHS pay and conditions as trust bosses cashed in on government plans to lift the cap on income from pay beds, private medicine, and deals with private companies.

“Andrew Lansley has made clear his wish to go further and make foundation trusts ‘off balance sheet’ as completely external providers to the NHS - meaning that their staff, too, would cease to be NHS employees,” he said.

Trust whistleblowing policies not up to scratch

By Mike Broad - 19th May 2010 5:08 pm

Some NHS trusts continue to make it hard for healthcare staff to raise concerns about patient care, an investigation has revealed.

A comparison of whistleblowing policy documents, from 118 of the 122 NHS foundation trusts, with guidance from Public Concern at Work showed some in an unfavourable light.

Twenty two of the 118 trust policies do not give examples of the types of concerns that should be raised, while four do not mention the option for a person to raise concerns outside of the trust.

More than a third of trust policies say staff can go outside the trust with a concern, but insist that a person goes through management first. Some mention that staff must go to an outside organisation ‘in good faith’ but warn that there may be disciplinary action if they go to them unjustifiably.

A fifth of trust policies do not specifically say they will respect the confidentiality of the whistleblower, or it is not clear that they will do, and 106 trusts mention sanctions against any malicious or false claims made.

Twenty two trusts mention “disciplinary” in their policies, a term unlikely to make potential whistleblowers comfortable in coming forward with a concern, while 30 trusts mention staff have a duty, implied duty, or loyalty to the trust as well as to patient confidentiality.

Commenting on the results of the BMJ investigation, Peter Gooderham, a law lecturer at the University of Manchester, said trusts should give assurances of protecting the whistleblower’s confidentiality.

He said: “It should be made clear that the finger won’t be pointed at them if they take steps to raise a genuine concern.”

He added that policies need to be user friendly and encourage people to raise concerns.

Dr Mark Porter, chairman of the BMA consultants’ committee, said: “We get very concerned about doctors who fall foul of these whistleblowing policies while following their professional duty. Members continue to raise examples with us, and there are high profile cases, some of which take place in organisations that have good policies.”

To address these issues, Public Concern at Work is to launch a policy pack on whistleblowing for distribution throughout the NHS in June. It also recommends that trusts audit, review, and check how their whistleblowing policies are performing in practice and promote their use to staff regularly.

A recent BMA survey revealed that around 1 in 7 hospital doctors in England and Wales who reported concerns said that their trusts had indicated that by speaking up, their employment could be negatively affected.

“Funds to stimulate competition being wasted”

By Mike Broad - 4th March 2010 6:22 pm

NHS reforms are failing to deliver widespread benefits, research reveals.

A study by think tank Civitas suggests that efforts to establish market forces within the NHS have been compromised by continuing centralised control.

On the plus side, reforms have led to improved access for patients, reduced waiting times and improved financial management. But, it claims the benefits are not widespread with weak commissioning, low levels of innovation, and poor professional and organisational collaboration.

Report author Laura Brereton said: “While there have been improvements, they are not clearly attributable to market based reforms. The NHS appears to be in the unfortunate position of taking on the extra costs of competition without realising the benefits.”

The report says patient choice has contributed to reducing waiting times but the uptake of choice is not widespread. The Choose and Book system on which it relies is restrictive, it says, and the quality of information on providers available to patients is weak.

It claims that the threat of competition has driven efficiency in some places. Quality of care, including patient satisfaction, is often seen to be better in new entrants such as privately run ISTCs. But competition has led to confusion over the relationship between commissioners and providers and made collaboration more difficult.

Foundation trusts have performed well financially and on routine quality measures, it says. But they were the best performing hospitals before their change in status and there is little evidence to suggest they’re more innovative.

Payment by results coincided with an increase in activity and efficiency, improved financial management and a decrease in unit costs. But the report says the setting of the tariff at the ‘average cost’ encourages providers to be average. Hospitals are also incentivised to induce demand inappropriately.

Problems are also highlighted with commissioning, particularly among PCTs which are accused of lacking the necessary skills to drive performance and purchase effectively.

James Gubb, director of the health unit at Civitas, said: “While the NHS is better than it was in 2002, wavering commitment to the idea of a market has unquestionably stymied the impact it could have had.”  

Read the full report.

Stand together and see off the contract threat

By Mike Broad - 11th February 2010 3:05 pm

So, the gloves have come off over consultants’ terms and conditions.

A leaked document by the Foundation Trust Network has revealed the full extent of employers’ intentions. An end to CEAs, reduced SPAs, capped pensions and frozen increments on pay progression are just some of them.

We know we’re in difficult times. But, if you were running a foundation trust, would you seek the answer in undermining and compromising the most important members of your workforce, or would you try to inspire them to work together to find real solutions?

It’s an incredible shame that a sizable proportion of NHS employers preferred to collude in secrecy rather than air and share the challenge with their senior medical staff.

Unfortunately, they will now pay a price for this. Their bond of trust with the consultant body is weakened and doctors’ representatives are on guard.  

We’ve started to see foundation trusts, with their greater independence, test national arrangements and offer non standard jobs. Sometimes they’ve done this for the right reasons, but frequently they’ve not.  

Maybe it was inevitable that they would test consultants’ nationally agreed terms and conditions more directly at some point. I’m sure the Foundation Trust Network, or even your individual foundation trust, will try to smooth things over by claiming it was just a discussion document. Don’t be fooled. This is not just about short-term savings, this is about getting consultants where they want them in future: cheaper, more acquiescent and clinically-focused.

Consultants have a contract which is fair - it rewards appropriately but not excessively. If foundation trusts want to change it, they should be forced towards national re-negotiation not local tinkering.

If piecemeal compromises start to happen locally - however the trust justifies them - all consultants will suffer eventually when inferior terms and conditions become common and ‘acceptable’. At that stage, they might not even ‘need’ the sub-consultant grade anymore.

The consultant body, and its representatives, have to show a united front and see off this very real threat.

Monitor sacks another foundation trust chairman

The Telegraph - 27th November 2009 6:25 pm

The chairman of Colchester Hospital University NHS Foundation Trust has been removed from his post over a series of failings, regulator Monitor has announced.

Richard Bourne was reappointed as chairman of the Trust in September, after chairing it for four years.

But Monitor has used its regulatory powers to force him to step down over concerns about patient safety, leadership and waiting times.

A statement from Monitor said: ”Regulatory action has been prompted by the trust’s failure to comply with healthcare standards, its failure to exercise its functions effectively, efficiently and economically, and serious and wide-ranging concerns as to overall governance and leadership at the trust.”

The news comes after Monitor intervened at another foundation trust, Basildon and Thurrock University Hospitals NHS Foundation Trust, after a damning report found poor hygiene and standards of care.

The foundation trust status is a supposed marker of excellence and allows NHS organisations greater financial freedom and control over their own affairs.

Bourne’s removal came as the head of the healthcare watchdog said the system of rating the NHS should be scrapped in the wake of revelations about hundreds of avoidable deaths at one hospital.

Baroness Young said that the current inspection regime which rates hospitals from “excellent” to “poor” was simplistic and should be replaced by a “much more sophisticated” process.

Read more at The Telegraph.

 

How important is foundation trust status really?

By Stephen Campion, HCSA chief executive - 6th November 2009 5:52 pm

Catching up on some late night reading (my contract requires me to work as many hours as needed to get the work done and makes no reference to SPA’s or flexible sessions) I could not help but marvel at press attention to foundation trusts.

A leaked memo from one foundation trust chairman to colleagues in Essex accuses Monitor - the foundation trust regulator - of being “unfair” and “intimidatory”.

In another story, the number of voters for the election of foundation trust governors has slumped. Then there was a report on how Dorset County Hospital appears to be yet another in an all too depressing, yet familiar, catalogue of trusts failing to meet the requirements of effectiveness, efficiency and economy.

Chairmen, chief executives turnover at an alarming rate; senior managers struggle to keep the foundation ship afloat, and medical staff find it difficult to reconcile the promised benefits of foundation status with swingeing cuts imposed in order for too many trusts to correct multi-million pound budget deficits.

So there was a lot to read, but not much news. We have heard it all before. I dozed off, thinking about the magic words of financial freedoms, accountability, value for money and public engagement.

I woke up realising that not much has changed since ordinary NHS trusts were introduced in the late 80’s and early 90’s. Even back then directly managed units were clamouring to achieve trust status, subject to an apparent show of consultation and public support.

I remembered one particular consultation exercise in the New Forest. Three separate trust applications led by three chairmen, chief executive designate and lots of senior bag carriers, of which I was one. There was one single person in the audience when the meeting was called to order - and he was the caretaker.

 Not a lot has changed really. But, what would happen if the meeting was called to close A&E?

Foundation trust can acquire GP practice

Healthcare Republic - 10th August 2009 11:24 am

A foundation trust’s acquisition of a practice in Sunderland will not create conflicts of interest, the Cooperation and Competition Panel (CCP) has ruled.

The integrated care organisation pilot will see City Hospitals Sunderland acquire the Church View medical practice to create a ‘vertically integrated’ healthcare system.

Organisations including the NHS Alliance have expressed concern that such a merger would represent ‘market capture’ - effectively enabling the foundation trust to generate cash by referring to itself.

But the CCP has said that the proposed merger will not breach current competition rules.

In his statement, director Andrew Taylor admitted there was a “risk… that those GPs will have an incentive to refer patients to their employing hospital”.

Read more at Healthcare Republic.

Quality compromised in pursuit of cheap volume

By Dr Tom Goodfellow, consultant radiologist - 27th July 2009 1:15 pm

Now I am not one to moan and I know that the most dangerous place in a hospital is reputed to be the door to the X-ray department at 5.00pm (you may get run over by the rush of radiologists leaving)!

But I had noticed that my work load seemed to be steadily rising despite my best attempts to prevent it.

So we decided to review the radiology work load figures for the last three years and the increases were quite unbelievable. CT had increased by 61%, ultrasound by 71% and MRI by a staggering 101% (and I am talking thousands of scans, not hundreds). This huge rise in demand for imaging investigations is reflected nationally, but I suspect we are at the extreme end of the curve.

The reasons for this surge are fairly straightforward. Firstly, we have abolished significant waits for investigations, an achievement for which we are justifiably proud. But this has effectively taken the lid off Pandora’s box - long waiting times were an efficient means of controlling demand.

Secondly, the combined effect of MMC and the WTD has resulted in junior doctors with far less experience and confidence than in former times. Consequently they have a much lower threshold for requesting imaging investigations. This is not a criticism, merely a statement of fact.

Thirdly, public expectations of what the health service can deliver continue to be inflated by politicians. I am reminded of a headline in the Daily Garbage some time ago: “Death rates continue to fall”!

It is true that a significant number of these requests are utterly inappropriate. Earlier today I scanned the kidneys of a frail confused elderly lady with deteriorating renal function. My report stated: “Bilateral 91-year-old kidneys”. We then shipped her off to have a CT scan of her brain (same age). I am not ageist and believe that appropriate investigations should be done at any age, but it’s difficult to know how the results would have altered her management.

You would expect that the response of the trust management would be to rapidly recruit additional general radiologists to deal with the increasing work load. Did they heck! We calculated the shortfall as between eight and 12 WTE consultants. Eight months after we raised our concerns they offered us four, then immediately reduced to three.

It is not as if we are not earning the cash. Last year, based on tariff, we brought in about £20m of business. However our actual annual budget is about £7.5m and we are expected to make a 5% cost improvement this year. We must be the most cost-efficient department in the whole hospital. Yet where has the cash gone? To support the most inefficient parts of the service who still fail to hit the targets despite having millions thrown at them (I mention no names).

So a pretty depressing story. We have managed the work load by ditching the easy things like IP reporting (perversely usually the sickest patients) and by generally reducing the quality of the work we do. Sadly this has resulted in clinical errors, some serious. The clinical governance issues do not need to be spelled out.

Our trust is travelling down the road towards foundation status, yet sadly it seems that nothing has been learned from the Mid Staffs debacle.

Foundation trust status key to raising quality

By Mike Broad - 13th July 2009 5:41 pm

Improving quality in the NHS against a backdrop of tighter public finances will be best achieved when all NHS trusts have achieved foundation trust status, claimed a regulator this week.

Monitor, the foundation trust regulator, said that just over half of all NHS trusts have been successfully authorised by Monitor as foundation trusts but faster progress is required to complete the transition to an all foundation trust model. 

Monitor’s Annual Report for 2008/09 describes how the regulator is responding to the challenges facing the NHS and urges all remaining NHS trusts not to lose focus in preparing their organisations for foundation trust status.

William Moyes, Monitor’s executive chairman, said: “Quick progress with ensuring that all hospitals are capable of being authorised as foundation trusts is essential to deliver Lord Darzi’s ambitious quality agenda and cope with future economic pressures.

“There is still some way to go before that is achieved. The half of our hospital system that has not yet managed to demonstrate that they can meet the leadership and financial standards required to become a foundation trust includes some of our largest and most complex hospitals.

“I very much hope that during 2009/10 we will see real progress with increasing the number of foundation trusts, particularly the larger teaching hospitals, and with developing realistic plans for those hospitals that are judged unlikely ever to be able in their present form to have the strength of governance and finance needed to secure authorisation.”

Weak appointment committees threaten safety

By Kathy Oxtoby - 26th June 2009 9:27 am

Some foundation trusts and independent sector treatment centres are foregoing the involvement of royal colleges when appointing consultants potentially putting patients at risk.

Doctors’ leaders warn that the consultant role is being devalued because these organisations are failing to vet their new appointments properly. Foundation trusts and ISTCs are not obliged to appoint clinicians through a formal Advisory Appointments Committee (ACC).

Mr Richard Collins, a consultant surgeon and council member of the Royal College of Surgeons with responsibility for advisory appointment committees, said the ACC process was established “to reassure the public that the clinician appointed to a post was appropriately trained, independently accepted and ideally the best possible candidate”.

Healthcare organisations which do not use the ACC process - which involves having a royal college representative and other senior clinicians on the interview panel - could be employing doctors on the basis of who, not what, they know and some may not even be suitably qualified for the post, Mr Collins said.

Dr Jonathan Fielden, the BMA’s consultant committee chair, said not having royal college input into consultants’ appointments meant it was harder to assure the quality of the person recruited.

Dr Fielden added that being able to sidestep ACC standards meant there was the potential for foundation trusts and ISTCs to recruit clinicians on non standard contracts with fewer than the 2.5 SPAs recommended in the consultant contract.

Mr Collins stressed that the majority of appointments “go smoothly”, but said the RCS had learned of cases where sidestepping the ACC process had caused problems.

These included an organisation recruiting a general surgeon for what should have been a plastic surgeon’s post; several employers have altered the days on which the ACC sits at short notice making it impossible for a royal college advisor to attend; and a growing number are offering irregular job descriptions.

David Worskett, director of NHS Partners network, said ISTCS had “rigorous appointment procedures” in place and that they “invariably have external assessors and experts, including members of the RCS”.

He added the appointment processes were “exactly those laid down by ISTC contracts required by NHS commissioners”.

A Department of Health spokesperson said it’s recommended that ISTCs “engage” with the royal colleges when making surgical appointments and that foundation trusts should “conduct their recruitment in a way that is legally compliant”.

However, Mr Collins said: “We need an independent, professional evaluation of the suitability of people being employed to work regularly within the health service.”

He added that there should also be a similar evaluation of one-off, short term appointments.