Saturday, November 17, 2007

Will my local hospital benefit from Foundation Trust status?

My local hospital - the PRH/RSH Trust in Shropshire - has applied for Foundation Trust status.

As I understand it the stated purpose of NHS Foundation Trusts is to devolve decision-making from a centralised NHS to local communities in an effort to be more responsive to local needs and wishes. Some see Foundation Trusts as akin to co-operatives, where 'local people', patients and staff can become members and governors and hold the Trust to account. The proposals for the PRH/RSH Foundation Trust suggest that the board membership will include 5 councillors from the Telford area, 9 from the rest of Shropshire and 2 from Montgomeryshire.

I have some major worries.

1. Will Foundation status lead to a two-tier system as in Canada, (where the quality of healthcare is considered to be excellent, but the World Health Organisation has recently highlighted that it has the longest waiting times for any developed country?

2. I am concerned as to whether the Foundation Members will actually succeed in having any effective influence over the hospital management. Recent experience in Shropshire appears (to me at least) to indicate that most senior health professionals (Consultants in particular) are resistant to accepting any guidance and advice from outside their profession.

3. Will Foundation Trusts end up copying practice in the US with some conditions being seen as more profitable, and the Foundation Trust is tempted to concentrate on those at the expense of others.

4. I also think that there exists the distinct possibility that individual Foundation governors can be misled to voting with the ‘management’ due simply to their medical ignorance. A study undertaken by the King's Fund of Homerton University Hospital NHS Foundation Trust found the governors disappointed and disillusioned.

“I regret to say that I wouldn't be able to pinpoint a particular point or issue that I have been able to achieve by my being a governor." Homerton University Hospital governor quoted anonymously

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 meeting that they only come to hear about after they have happened. This study was funded by the Nuffield Foundation and was echoed in British Medical Journal, as was The King's Fund findings. After sitting on a Foundation Board for two years one Governor told the Nuffield researchers:

“If governors have little real influence it will be hard to claim that foundation trusts represent a leap forward”

All in all I am personally unconvinced as to the benefits of Foundation Trust status. Am I right to be cautious? What is the experience of others?

No comments: