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NHS chief challenges foundation hospitals plan

The Guardian - 28th September 2011 9:16 am

The government’s health reforms ran into further trouble on Tuesday when the chief executive of the NHS publicly challenged a key proposal.

As peers prepare to table a series of amendments to the health and social care bill, Sir David Nicholson said the government was wrong to block failing foundation hospitals from returning to direct NHS control.

Andrew Lansley, the health secretary, wants to repeal a provision in the 2006 National Health Service Act which allows for the “de-authorisation” of failing foundation trusts, triggering their return to NHS control. The change is designed to strengthen foundation trusts - a central element of the government’s plans to decentralise power in the NHS - which will eventually take over the running of all hospitals in England.

In evidence to the public inquiry into failings at the Mid-Staffordshire NHS Trust, Nicholson called on the government to retain the renationalisation of a failing trust in its “armoury”.

It’s up to all of us to explain the risks of NHS reform

Dr Mark Porter, chairman of the BMA's consultants committee - 11th February 2011 9:09 pm

Every time I hear a BBC report on NHS reform I know it’s coming. When I start reading any newspaper story I know it’s not more than a couple of paragraphs away. The phrase “the plans, which would hand the NHS budget over to GPs” is how journalists sum up 367 pages and 288 clauses of the most far-reaching NHS legislation ever.

Well, yes of course the creation of a model of clinician-led commissioning is among the most important things the Health and Social Care Bill would do. The problem is that it would also do many other things which will quite possibly affect hospitals far more, but which you’re less likely to hear debated on the Today programme.

They’d make locally negotiated terms and conditions a very real and very worrying prospect. They’d make foundation status obligatory - by 2014 - and allow foundation hospitals to generate more income from non-NHS activities. And, by opening up more services to providers, competing on the basis of price, they could destabilise the way your hospital can continue to offer a comprehensive, universal and high quality service.

If any of these issues bother you, now is a good time to be talking to your MP. It’s up to us, both as individual doctors, and collectively through bodies like the BMA and the medical royal colleges, to explain what the realities and risks of the changes would be. The BMA has launched a new lobbying tool kit that suggests key areas which you may want to raise with your MP.

Whether we’re going to completely overthrow a programme of reform on which the government is determined is questionable, but there is much we can do to change it, and to remind politicians and the public that the Bill is about so much more than who controls the purse strings.

Tags: Foundation trusts, Health policy
Posted in BMA | 2 Comments »

Foundation trusts seek to halt automatic pay rises

HSJ - 28th September 2010 8:19 pm

Foundation trusts are drawing up plans to freeze automatic pay increases in a move which could affect up to half a million NHS staff.

HSJ has spoken to foundation trusts in five of the 10 strategic health authority regions which say they desperately need to freeze Agenda for Change increments in order to make cost savings of 4‑5% a year for the next four years.

As yet, no foundation trust has gone public with its plans and all hope the Department of Health or the Treasury will heed their quiet lobbying and implement a national freeze instead. However, some have indicated that they are prepared to go it alone if necessary.

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.

Tags: Foundation trusts, Private practice
Posted in Hospital Dr News | No Comments »

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.

Tags: Foundation trusts, Whistleblowing
Posted in Hospital Dr News | 2 Comments »

“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.

Tags: Foundation trusts, Patient choice, Privatisation
Posted in Hospital Dr News | 2 Comments »

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.

Tags: Consultant contract, Foundation trusts
Posted in Dr Blogs | 5 Comments »

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.

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?

Tags: Foundation trusts
Posted in HCSA | No Comments »

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”.