Written evidence submitted by Foundation
Trust Network (BS 93)|
The Foundation Trust Network (FTN) is the independent
membership organisation for authorised NHS foundation trusts and
those aspiring to achieve foundation trust status. We have over
200 member organisations from the acute healthcare, mental health,
ambulance and community services sectors.
The FTN welcomes the opportunity to submit evidence
to the Public Administration Select Committee.
We would suggest that any definition of Big Society
would include a new definition of "public ownership"
quite different from the statist ownership of the past, so that
local communities can have a direct influence over the nature
and scope of the services they receive and are able to hold to
account the professionals who deliver those services. But if accountability
in public services is to be meaningful it needs to be democratic
and inclusive, so that the views of all stakeholders are taken
into account. It also needs to be structured so that the accountability
process is transparent, manageable and accessible.
The Department of Health's command paper (published
in December 2010) reinforces the success of the foundation trust
movement to date when it stated that FTs comprise one of the largest
and most vibrant social enterprise sectors in the world.
NHS foundation trusts are now nearly seven years
old. Having grown from twenty FTs in 2004 to 136 in March 2011,
the FT sector offers a wealth of experience in terms of establishing
independent, decentralised provision in public services that engages
the community, service users and stakeholders. The sector has:
acute foundation trusts.
mental health foundation trusts.
1.8 million members (and growing).
governors (and growing) made up of the public and service users
(over half); staff and local stakeholders/partner organisations.
with turnovers ranging from £80 million to £800 million.
value of over £30 billion.
trusts community services are preparing for authorisation.
Central to foundation trusts' progress is the unique
nature of the corporate model that is applied to foundation truststhe
public benefit corporation. With freedoms and responsibilities
similar to the private sector, but incorporating elements of social
enterprise, the foundation trust model was developed to ensure
the best return on investment for public assets in terms of efficiency,
quality and the longer term sustainability of services that are
vital to public well being. Foundation trusts remain public sector
organisations based on the values of the NHS, with behaviours
that derive from those values. They do not distribute their surplus,
rather they reinvest it in improving health services in the short
and long term.
Foundation trusts are governed by a corporate board
and locally accountable to an elected board of governors. They
are authorised by and accountable nationally to the regulator
Monitor, on the grounds that they achieve robust financial and
governance performance and are then free to operate independently
of state performance management. Under Health and Social Care
bill proposals, Monitor's direct responsibility for FTs will disappear
when they take on a broader role as the economic regulator.
Locally they are accountable to local communities
and stakeholders via their governors elected by three constituencies
of public, patients and staff. The Health and Social Care bill
strengthens the role and duties of the foundation trust governors.
This governance structure and accountability is what frees foundation
trusts from central control.
The authorisation process gives foundation trusts
commercial freedoms not available to other non-authorised NHS
organisations that have some parallels with private sector operators,
and like all independent organisations foundation trusts carry
their own liabilities and are responsible for their own risk management.
The scale, independence and complexity of foundation trusts means
that the corporate boards operate at the same level as FTSE listed
companies; they are entrepreneurial with a "go anywhere"
and "be ready for anything" mindset, focused on social
aims and aspirations.
The FT model has proven itself in terms of efficiency
and governance. It has demonstrated its potential to overcome
that age old problem of public sector inertia, inefficiency and
lack of customer responsiveness and develop a "can do"
spirit. And it represents a realistic rolling back of the state
to accommodate a modern pluralistic democracy that incorporates
the spirit of voluntarism and community solidarity.
In essence, the foundation trust model:
the management of risk to feasible levels with right expertise.
continuous improvement, drive for efficiency, investment in locally
essential services with customers, service users and local communities.
a key role in re-building participation and pride in civil society.
The FTN believes that the foundation trust modelwith
its local membership and elected governors - exemplifies many
of those elements that make up the concept that is the Big Society.