Monday, 10 May 2010

Foundation Trusts

Once the dust has settled and we have a functioning government again, attention will quickly turn to addressing the UK’s huge budget deficit. Although Mr Cameron has promised to preserve front line services it would be naive to assume the NHS is going to escape the axe.

Foundation Trusts were announced in 2002 by Alan Milburn.

There are now some 170 acute hospital trusts in England of which more than half (89) have acquired Foundation status.

So what is the difference between a Foundation and an “ordinary” trust? Foundation trusts are overseen by (yet another) government body called Monitor. The differences between the two types of trust are set out on their web site here. Perhaps it is just cynical old me but the differences described don’t fill me with enthusiasm. It looks mostly like window dressing and waffle to me. Although Monitor suggests that Foundation trusts “can be more responsive to the needs and wishes of their local communities” they don’t say how or in any way support this assertion.

So is there any evidence that Foundation trusts provide a better service than other trusts. This report shows that of 25 trusts apparently having excess death rates 15 have foundation status. The report also highlights the unsurprising discrepancy between self assessment and external assessment of trusts’ performance. This report points out that two of the most criticised trusts in England have Foundation status. If Foundation trusts did provide a better service, then by definition the NHS would provide a two tier service, totally contrary to founding principles.

So why are chief executives so keen to acquire Foundation status. It certainly doesn’t come from front line staff most of whom see no advantage, or patients whose expectations tend to be far more mundane. This report I think might hold the answer “According to the IDS research the median salary for a chief executive of a NHS foundation trust stood at £157,500 for the year to March 2009, compared to £147,500 for a chief executive of a non-foundation NHS trust.”

So a tip to the incoming Health Minister. Dumping this failed experiment will probably save money and encounter precious little opposition.

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