- NHS Foundation Trust
NHS Foundation Trusts (often referred to as "foundation hospitals") are hospitals which are part of the
National Health Servicein England.
They have a significant amount of managerial and financial freedom when compared to existing
NHS Trust. The introduction of NHS Foundation Trusts represented a change in the history of the National Health Serviceand the way in which hospital services are managed and provided.
This form of
NHS Trustis an important part of the UK Government's programme to create a "patient-led" NHS. Whilst their stated purpose is to devolve decision-making from a centralised NHS to local communities in an effort to be more responsive to their needs and wishes, others however see the change towards semi-independent hospital boards as a move towards privatisationof the health service.cite web
title =Foundation Trust Watch
accessdate =2007-09-15 ]
Foundation Trusts are considered mutual structures akin to
co-operatives, where local people, patients and staff can become members and governors and hold the Trust to account. Some trusts are more committed to co-operative principles and have even written the Rochdale Principlesinto their constitution and aspire to work closely with other mutual organisations. [South London & Maudsley NHS Trust. [http://www.slam.nhs.uk/about/foundation/Our%20Bold%20Vision.pdf Our bold vision] . Accessed 2007-09-16]
NHS foundation trusts are authorised and regulated by Monitor, the Independent Regulator of NHS Foundation Trusts. A full list of NHS foundation trusts can be found on their website. Monitor: Independent Regulator of NHS Foundation Trusts [http://www.monitor-nhsft.gov.uk/register.php Public Register of NHS Foundation Trusts] . Accessed 2008-05-19]
Comparison with other hospitals
Unlike hospitals outside the NHS, Foundation Trusts have a cap on the proportion of their income that can come from non-NHS treatments, such as from fee-paying patients.Cite web
title=Foundation hospitals: Frequently asked questions
Foundation hospitals were announced by Health Secretary
Alan Milburnin 2002.Cite news
title=Milburn unveils hospital franchise plan] By May 2008, the Monitor website listed over 100 Foundation Trusts.
The introduction has not been without its critics. Some pointed out that Foundation Trusts go against the spirit of the principles laid out by
Aneurin Bevan(who founded the NHS). Others said that it will lead to a two-tier system, as in Canada, and whilst the quality of healthcare in their system is excellent, the World Health Organisationhas discovered it has the longest waiting times for any developed country. Worse, for those than can no longer afford private insurance, accessing it through the publicly funded side proves most difficult with many not succeeding.Citation
last =World Health Organisation
title =The World health satistics
url =http://www.who.int/entity/whosis/whostat2007.pdf ] Another doubt, is whether the Foundation Members will actually succeed in having any effective influence over the hospital management. History seems to have proven, that since the 1600s entry process into the higher echelons of medicine (and especially those of surgeons and physicians) has a counter tendency of selecting those -who are by nature- steadfastly resistant to accepting guidance and advice from outside their profession. A further concern, is that Foundation Trusts will quickly copy the USA and come to see some conditions as more profitable, and concentrate on those at the expense of others. The 2007 WHO report found that despite expenditure being almost double of the UK, the resulting outcomes were no better. [WHO survey (2007) [http://image.guardian.co.uk/sys-files/Guardian/documents/2007/09/12/WORLD_HEALTH_1209_graphic.pdf Graphical representation of different outcomes and expenditure] . Accessed 2007-09-16]
Also, there exists every possibility that individual Foundation Members can be misled to voting with the management due simply to their medical ignorance. For example: Lay people may be easily led to believe that spending money on a new scanner, then spending more money on using it for frequent screening for cancer will improve survival rates. However, all that happens is that earlier detection starts the clock ticking earlier. Therefore, whilst the clock runs for longer it is without the benefit of overall increases in real and absolute survival times - but it looks good in the performance tables. However, the expenditure on such high technology may well take money away from many more less spectacular, but more life-prolonging and more life-enhancing services in other healthcare areas.
A study undertaken by the
King's Fundof Homerton University Hospital NHS Foundation Trust found the governors disappointed and disillusioned.
Another report found, was that it is too easy to invite members to sit on sub-committees, where they quickly become bogged down in the minutiae of operational planning, whilst the main decisions are taken at meetings that they only come to hear about after they have happened. [cite journal
first = Madeleine
title =Local control over foundation trusts is "rhetoric"
journal =British Medical Journal
accessdate =2007-09-16 | volume =330
pages =1408] This study was funded by the
Nuffield Foundationand was echoed in British Medical Journal, as was The King's Fund findings.
cquote2|If governors have little real influence it will be hard to claim that foundation trusts represent a leap forward |anonymous governor| [cite journal
last = Day
title =Foundation hospitals are not accountable to their communities
journal =British Medical Journal
accessdate = | volume = 331
pages = 926]
The older existing NHS system was praised in 2007 by the documentary maker
Michael Moorein his film Sicko.
Health care in Canada
History of the National Health Service
Publicly funded health care
Universal health care
* Criticism of the NHS
List of NHS Trusts
* cite book
last = Pollock
coauthors = Colin Leys
title =NHS plc : the privatisation of our health care
publisher =Verso Books
pages = pages 75-295
isbn = 978-1844675395
* Allyson Pollock (2007-09-24) The Guardian: [http://www.guardian.co.uk/g2/story/0,,2175622,00.html What Sicko doesn't tell you...] Accessed 2007-09-25
* [http://www.monitor-nhsft.gov.uk Monitor]
* [http://www.nhsconfed.org/ftn/ NHS Confederation Foundation Trust Network]
* [http://www.hmso.gov.uk/acts/acts2003/20030043.htm Health and Social Care (Community Health and Standards) Act 2003] (2003 Chapter 43)
* [http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/SecondaryCare/NHSFoundationTrust/fs/en Department of Health information on NHS Foundation Trusts]
* [http://www.monitor-nhsft.gov.uk/ Independent Regulator of NHS Foundation Trusts] (official site)
* [http://www.monitor-nhsft.gov.uk/register.php Public register of NHS Foundation Trusts]
* Unison (January 2007 Revised edition). [http://www.unison.org.uk/acrobat/16299.pdf In the Interests of Patients? The impact of the creation of a commercial market in the provision of NHS Care] . Accessed 2007-09-15
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