"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Friday, 14 January 2011

FT Membership

There are 132 Foundation Trusts in England and these provide acute, mental health and community care. An FT is a "public benefit corporation" which is meant to be loosely based on the mutual concept, that is, the service user "owns" the provider. The way it works is that every FT has a membership, which is some combination of patients, carers, staff and the people living in the geographical locality (interestingly, members can be as young as 16, younger than the age of majority).
Pulse have produced a short guide to FTs and this point seemed interesting to me, referring to FT membership:

But according to David Stout, Director of the PCT Network at the NHS Confederation, this could potentially undermine a consortium’s claim to be the representative of patients locally: “Through their governance strategy Foundation Trusts have a system of membership. Patients are members of Foundation Trusts and that gives the trust some legitimacy in how they operate within the health system – they can say they genuinely represent patient views. That’s potentially a challenge to [GP] commissioners who also claim to represent patient interests and patient views. If you as a commissioner want to redesign services in a way that takes care out of the hospital and puts it closer to home in general practice or community services and the hospital is resistant to that change then their well-developed system of patient representatives might be a challenge to your decision making.”
Lansley says that he will not provide instructions about how GP Commissioning Consortia are managed. He will not require patient involvement (indeed,, he does not even require GP involvement in the consortium board).

The NHS white paper partially acknowledges that FT membership could be seen as more legitimate making the FT boards more accountable than GP consortia where it says:

We will consult on future requirements: we envisage that some foundation trusts will be led only by employees; others will have wider memberships. (4.21)
This seemed to indicate a weakening of the membership model. However, Next Steps, the government's response to the white paper consultation, says:

The Government has considered these concerns and concluded that staff-only
membership would not be compatible with the foundation trust model.(6.17)
Which removes the threat of employee-led ownership (management buy outs) but the document does not provide any more detail on the consultation on membership promised in the white paper. Next Steps does say:
The Health and Social Care Bill will make explicit the duty of governors to hold the board of directors to account, through the chair and non-executive directors (whom they have power to appoint and remove); (6.15)
There is no equivalent public accountability of GP consortia. This means, as David Stout points out, FTs will have memberships, consortia will not.

I wonder if, in the future, we will see a clash between FTs and GP consortia, particularly if the consortia demand service changes (which may involve closing part, or all of a hospital) and the FT refuses stating that they have the support of their membership and hence greater public legitimacy and accountability.

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