The NHS Foundation Trust - Essay Example

?NHS Foundation Trusts Introduction NHS foundation trusts are referred to as foundation hospitals. They were introduced after the enactment of Health and social (community health and standards) Act of 2004 (Davies 2008). According to the Department of Health, the main reason for implementation of the NHS is to allow for devolution of the health services (Davies 2008). The NHS foundation trusts are “public benefit corporations” managed by the local community rather than the central government. According to the Department of Health, foundation trusts transfers the ownership of the medical care facilities and the quality of services determination to the local communities (Davies 2008). The trusts are licensed by an independent regulator and receive funding depending on health activity that the trusts undertake in delivering services to the local people (Davies 2008). Currently there are 143 NHS Foundation Trusts whereby 41 of them are mental health trusts while 3 are ambulance trusts. According to the Department of Health, NHS Foundation Trusts were implemented to improve access to quality healthcare services by engaging the local community in the services provision (Davies 2008). NHS foundation trusts differ from other NHS trusts in a number of ways. According to the Department of Health, NHS foundation trusts are independent public benefit entities and are accountable to the “members” who are the local people who participate in the management of the entities (Davies 2008). Each NHS foundation is required to consult with the board of governors that comprise of the patients, the employees, members of the public and partnering organisations is the strategic decision making process. The NHS foundation organisations are autonomous since are not controlled by the central government or under any management by the local health authorities (Dimond 2011). Foundation trusts have the freedom to invest in capital projects that aim at improving the quality of health care services. According to Department of Health, NHS foundation trusts fiances are controlled by the Monitor which is an independent regulator accountable to Parliament (Dimond 2011). The monitor reviews the financial performance of each NHS foundation trust to assess the financial stability and risk and the level of compliance to the authorisation terms and conditions (Dimond 2011). NHS foundation trusts can negotiate for financing from the department of health on periodic basis like 3-year plans instead of annual basis (Dimond 2011). NHS foundation trusts are able to retain proceeds from asset disposals, raise capital in both private and public markets and retain surpluses free from central government control (Dimond 2011). NHS foundation trusts can borrow both finances without any external approval as long as they can afford to repay (Dimond 2011). The amount of borrowing is determined by the Prudential code that determines the ability to repay the debt from the streams of revenues expected in the future. According to Monitor, land and buildings of the NHS foundation trusts are protected and cannot be used to secure funding (Dimond 2011). The foundation trusts have financial freedom that allows them to raise funds from both the public and private sectors depending on their cash flow forecasts (Dimond 2011). According to Monitor, they can retain surplus amounts for investment purposes in delivery of new NHS services. They are not subjected to performance management by health authorities or the Department of Health, and can recruit and determine the pay for staff subject to minimal national standards like Agenda for Change (Dimond 2011). Proponents of NHS foundation trusts Proponents of Foundation Trusts assert that freedom from the control of central government makes the Trusts more accountable to the local communities and the patients. They argue that the Trusts are innovative in their service delivery hence can meet the health needs of the community. The patients, the local people and staff of the foundation trusts actively participate in the running of the hospitals thus creating a feeling of ownership. The hospitals have the freedom to set priorities in their health care provision based on the health needs of the local people. Proponents of the foundation trusts assert that the Trusts receive payments for the services offered and can re-invest the funds in the provision of more health services; hence, they are capable of delivering high quality healthcare services (Dimond 2011). NHS foundation trusts operate on the basis of working together with the public in providing free health care services to according to the needs of the health care service users. They are supposed to meet the standards of health care provided by the appointed regulator (Davies 2008). Another strength proposed by proponents is that the foundations trusts have the freedom to borrow money in the public and private sector markets based on their cash flow forecasts, instead of waiting for the government funding. They argue that Foundation Trusts are capable of investing in state of modern facilities that improve access and quality of health care. The governance of the NHS foundation trusts allows for a quick decision making process since the board of governors is composed of the local people, the care providers, the staff and patients who are chosen by the patients, the members of public and the staff of the hospitals (National Audit Office 2011). Proponents of Foundation Trusts believe that the staffs enjoy better opportunities in the provision of health services like better salaries and other incentives. They argue that these Trusts will attract and retain high qualified staff due to enhanced reputation; the staffs receives regular communication and is consulted in future investments and developments in the service delivery. Proponents assert that since the staff forms part of the Board of Governors, they play critical roles in the decision making, hence are motivated in their duties (Davies 2008). Accordingly, the proponents of these trusts claim that increased flexibility allows for better staff rewards and incentives thus they can concentrate on, quality service delivery rather than fulfilling their duty to the central government (Davies 2008). The NHS foundation trusts have the authority to borrow finances from the capital markets; they can invest in modern health facilities like new machinery thus improving the quality of care (Davies 2008). The staff is allowed to participate in the management of the health facilities and decision making on the quality of services required thus have the opportunity to air their grievances on the service delivery (Davies 2008). NHS foundation trusts can utilize their surplus income to hire more staff and to increase the salaries thus employees will remain committed to their duties of providing quality health care services to the community (Davies 2008). Opponents of NHS foundation trusts These trusts have certain shortcomings since they are perceived to have an unfair advantage in the competition of patients and funding. Opponents of NHS Foundation Trusts assert that due to perception superior status and financial freedom that allows these trusts to upgrade their facilities and services, they can easily destabilise other NHS Trusts financially by attracting many patients thus leading to closure of small general hospitals. Another weakness put forward by opponents of NHS Foundation Trusts is that the trusts are acting as a backdoor of privatisation of the crucial health care, whereby private providers will be contracted to offer certain specialised services. Foundation Trusts may fail to increase local accountability and ownership since such hospitals should be owed by the public but not a small group of the population (Dimond 2011). According to available evidence, Foundation Trusts have no standardized governance mechanisms since the roles of the Governor are not clearly demarcated, thus, these Trusts risk losing accountability to public (Dimond 2011). The opponents argue that Foundation Trust members select the Board of Governors; hence, small ethnic and other social groups that benefit from the trusts may not be represented. They argue that most of the Foundation Trusts have not established checks and safeguards that ensure the Board of Governors fully consult with the members and especially the minorities in decision making and service delivery process (National Audit Office 2011). The opponents assert that Foundation Trusts may not achieve value for their money when they decide to borrow in the private sector to finance capital investments, due to higher interest rates than they could have incurred while borrowing from the public sector (National Audit Office 2011). Another weakness cited by the critics is that these have the urge to improve their facilities and services; hence, government funding may not be enough which leads to borrowing in the private markets at high interest rates which is not economical. The Treasury may be forced to bail out Foundation that goes bankrupt thus creating additional burden on the already limited public revenues (National Audit Office 2011). Opponents point out that since the trusts are independent legal entities, it will be expensive to administer, due to high legal costs of preparing binding agreements with other partner organisations. Foundation Trusts exercise flexibility of staff pay thus will draw staff from NHS Trusts due to demoralisation of the patients and staff in those Trusts that are yet to attain Foundation status (National Audit Office 2011). Critics argue that NHS Foundation Trusts undermine the efforts of the government in integrating the healthcare services since they strengthen the existing institutional boundaries (National Audit Office 2011). They assert that independency of these Trusts will prohibit the government from standardising the quality of healthcare across the country. Foundation Trusts may select patients to treat is the demand for their services exceeds the level listed in the license thus creating inequity of access by rejecting patients with higher than average costs and focusing on the patients where they make more profits (Parliament House of Commons Health Committee 2007). It has been argued that NHS foundation trusts concentrate on non-NHS patients when their capacity is constrained in order to increase their revenues (National Audit Office 2011). All NHS Foundation trusts are run by different board of directors though they are regulated by the Monitor, thus there is a high likelihood of variance in the quality of services offered by the foundation trusts (National Audit Office 2011). All NHS foundation trusts have different authorisation terms and conditions that they must maintain; the Department of Health is not able to standardise the service delivery process of all NHS foundation trust (National Audit Office 2011). The NHS Foundation Trusts that have been opened have increased access to services and improved the quality of care for patients (Davies 2008). The activity level of NHS foundation trusts increased in 2007-2008, the medial consultations increased by 2 percent from 289 million to a high of 295 million (Davies 2008). The emergency admissions also increased by 0.4 percent including the procedures that were performed by NHS foundation trusts. The patient inpatient waiting time reduced from 7.4 weeks in March 2007 to about 5.5 weeks in March 2008. The outpatient waiting time declined from about 3.7 weeks in March 2007 to about 2.9 weeks in March 2008 (Davies 2008). The Healthcare Commission noted improvements in the number of NHS trusts including the Foundation trusts that were rated as excellent in quality care provision. The proportion of Trusts rated as excellent increased from 16 percent in 2007 to 26 percent in 2008.According to the Healthcare Commission, NHS foundation trusts were rated highly than other NHS trusts while the Primary care trusts were rated the lowest (Davies 2008). The Foundation Trusts have improved the relationships within the local community health provision partners through engaging the local communities in decision making (Parliament House of Commons Health Committee 2007). Foundation trusts have implemented numerous outreach events and volunteering projects that aim at disseminating both written and oral information to the local population (Davies 2008). Through working with the ‘members’, who are the communities surrounding the NHS foundation trust, the NHS foundation trust have been able to reduce the number of patient complaints and emergency admissions by 50 percent due to improved relationships with the local population (Davies 2008). The foundation trusts have managed their finances according to the financial management framework and increased investment in healthcare education and training (Viner 2008). However, in some Trusts, the engagement of the staff in decision making has been low due to the high influence of the Board of Governors in decision making (Parliament House of Commons Health Committee 2007). Some NHS Foundation Trusts have made improvements in car parking, refurbishment of lifts, heating and air conditioning. Due to flexibility of borrowing and investments, some Foundation Trusts have been able to build operating theatres and surgical units (Viner 2008). NHS Foundation Trusts have implemented the Local Improvement Finance Trust which is geared at improving local infrastructure. Examples of premises which have been financed include St Peter’s Centre in Burnley which provides health and leisure facilities (Viner 2008). The patient waiting time has decreased significantly due to quick response that has been occasioned by increase in employees and commitment to service delivery (Viner 2008). The number the numbers of patients have been increasing overtime due high satisfaction levels (Viner 2008). The number of emergency admissions has also increased due to increase in capacity (Viner 2008). Conclusion The government and Department of Health should continue licensing additional Foundation Trusts. NHS Foundation Trusts were created to improve the local accountability and ownership of the health care service provision. The Trusts have the flexibility in financial management and recruitment of staff. The Foundation Trusts have increased access and quality of healthcare due to investment in modern medical equipment and employment of additional staff. The Foundation Trusts have expanded their services due to income surplus and ease of borrowing and utilisation of resources. The NHS Foundation Trusts have improved access to quality health care among the local community; hence the Department of Health should promote the licensing of other Foundation Trusts. According to Healthcare Commission, the trusts have reduced the patient waiting time and increased the inpatient admissions by more than 50 percent. Bibliography: Davies, P. 2008. The NHS handbook: 2008/09. London. NHS Confederation. Dimond, B. 2011. Legal aspects of occupational therapy. London. Prentice-Hall. Great Britain: National Audit Office. 2011. Achievement of Foundation Trust status by NHS hospital Trusts: department of health. London. TSO. Great Britain: Parliament House of Commons Health Committee. 2007. Patient and Public involvement in the NHS. London. Stationery Office. Monitor: the independent Regulator of NHS Foundation Trusts. NHS Foundation trust directory. Accessed on 8th March, 2012 from: http://www.monitor-nhsft.gov.uk/about-nhs- foundation-trusts/nhs-foundation-trust-directory Viner, K. 2008. NHS Foundation Trusts. London. ICSA Publishing Limited. Read More