The establishment of NHS foundation trusts has been perhaps the most radical experiment in public service reform of our generation. For the first time since the creation of the NHS, acute and mental health providers are being given the opportunity to become mutually owned bodies, regulated at arms length from the Department of Health and accountable to a widely defined membership. This has enabled a new model of healthcare that is controlled and run locally; giving staff, local communities and other stakeholders a far bigger voice in how hospitals are run.
Four years on, the predictions of doom have proved to be totally unfounded. No foundation trust has been ‘captured’ by special interest groups or private companies looking for hospital contracts. The legislative requirement for trusts to seek to ensure that their membership is representative of their wider community has forced trusts to engage more widely with their local communities. Turnouts at elections have often dwarfed those for local government, showing that the affinity for this form of governance is strong.
Since April 2004, 107 NHS foundation trusts have been created, with a total membership of well over a million. A review of membership governance, recently published by the Department of Health, has shown that the unprecedented level of patient and public involvement in healthcare is making a real difference. It concludes that governors and members are changing the way that their hospitals are run, making them more responsive to local people and more focused on patients’ needs.
One chief executive has highlighted the manner in which the foundation trust structure has helped to improve attitudes towards the ‘patient experience’. He stated that ‘before authorisation board meetings were almost solely concerned with technical goals, such as progress towards targets and the state of finances. Having a membership has meant that it is now as common for us to look at ways in which we can improve the experience of hospital patients, alongside these other concerns.’
Evidence from the Healthcare Commission’s April staff survey would support this proposition. Of the 34 foundation trusts that had been authorised for two years or more, 59 per cent of their staff agreed with the statement ‘care of patients/service users is my trust’s top priority,’ in comparison with an NHS-wide average of 46 per cent.
And evidence from the membership governance review suggests the same. One example is Royal Devon and Exeter NHS Foundation Trust, where they have used questionnaires and focus groups of members to create an iterative process to formulate trust strategy, integrating the desires and needs of its membership into the process. One of the cornerstones of this strategy is the trust’s long-term objective of accommodating all patients into single rooms, which was seen as fitting in with not only what patients want in terms of service, but also the clinical goal of reducing the spread of infection.
Four years into the NHS foundation trust story, it is surprising that more has not been made of the quiet revolution that has taken place. Given the impact that the model appears to have had on service delivery, we could certainly suggest that it has wider applications for public service provision across departments.
The recent thrust of Co-operative party policy has been to outline a new approach to politics – that of ‘politics for people’. Its basic premise is rooted in the rights of citizens, bringing real accountability to the organisations that affect our everyday lives.
It is about the transfer of power from government to the governed, power for people in every sphere of their lives; from their place of employment, to the homes in which they live, and the public services they rely on. What the foundation trust experience has shown us is that this approach to government can deliver for the people that matter. With all the discourse around ‘double devolution’ and ‘empowerment,’ it seems the time for the mutual approach to public services has finally come.
Robbie Erbmann makes grand claims for the “Quiet Revolution” in health care allegedly wrought by Foundation Trusts. In particular he asserts that “turnouts at elections have often dwarfed those for local government.” But the electorates are not comparable. The local government electorate embraces the whole adult population, the foundation trust electorate is self-selected. So any analysis of turnout needs to reflect what proportion of the whole population has enlisted as members of trusts, and what proportion of those voting are staff members or lay members. Perhaps Robbie could enlighten us, but given that on his own account total membership is only a million, or an average of 9.5 thousand per trust, of whom a considerable number must work for the NHS this is hardly a mass movement.
There are, moreover, other ways in which the NHS can be made more accountable, especially through properly resourced scrutiny undertaken by local councils with participation from patient and community groups.
Coun Sir Jeremy Beecham, Leader LGA Labour Group
I’d agree with Jeremy Beecham : as elected reps of the local community (including hospital users), local councils should have a big say in how local NHS is run.