Foundation Trusts – a real threat the the very existence of the NHS

NHS Foundation Trust Consultation: GMB Union Wiltshire and Swindon Branch Response

A Fundamental flaw in the consultation document

Wiltshire and Swindon Branch of the GMB represent staff working within the Swindon and Marlborough NHS Trust and also patients and potential patients of the trust. Wiltshire & Swindon GMB considers that the ‘consultation’ process is fundamentally flawed because it denies local people and staff the opportunity to discuss whether Foundation Status is desirable, sustainable or necessary, nor does it allow a full discussion of the implications of Foundation Status both for the local and national NHS.

Considering the large focus throughout the consultation document on the importance of the views of patient’s, local people and staff, it is ironic that all of these groups have been denied the right to have any say on whether or not they would like their local trust to convert to a Foundation Trust with all that entails.

Therefore although we are not specifically asked for views regarding the fundamental decision about Foundation Trust status, in line with GMB national policy and the feelings of local members to express our opposition to the prospect of the trust requesting Foundation status.

We believe that the consultation document is heavily biased, outlining the positives of a proposed change but no comment on any possible negative outcomes. Although the principle of Foundation Trust is not out for consultation, we should be give the full facts regarding what negatives there are.

The GMB Position regarding the principle of Foundation Trusts

GMB oppose the creation of Foundation Trusts. We consider this form of organisation as posing a real threat to the very existence of the National Health Service.

Many health experts agree that Foundation Trust status will introduce profit and competition into the NHS and mean that financially better off hospitals will be able to poach staff from less well off trusts.

With competition firmly rooted, NHS Trusts will compete with one another and will spell the end of the sharing of good practice that exists today. Instead Trusts will compete with one another and waist money on advertising etc.

The increasing marketisation of the NHS will inevitably threaten the national dimension of the NHS and in the long term threaten the universal principles which underpin Britain’s health service.

We are opposed to Foundation Status in principle because it is central to the government’s strategy of a competitive market in which Trusts compete with each other and with private companies for patients.

The more the Trust operates like a business the more patients and potential patients are subordinated to profit making.

Subjective/Misleading statements in the consultation document

Main advantage of Foundation status is that it will bring us even closer to the people who work for us and the people we care for.”

In this section there is no mention of trade unions being an active part in this relationship. There is already an existing negotiating structure within the trust where trade unions and the employers communicate. It is not by any means clear how or what Foundation status will bring the trust closer to the needs of the local community, there is a huge variety of numbers engaging with existing trusts as members and the impact that they have in terms of strategic policy making and to services on the ground is not proven.

We also believe that the consultation is further flawed by the failure to include the governance arrangements in the consultation. The relationship between members, governors and the Board of Directors is critical because it will determine who has the power of decision. For instance, if there is a proposal to stop doing work currently done, owing to financial or other reasons., will the members have the power to vote down such a proposal?

Healthcare is our Business”

The statements contained in this paragraph are subjective opinions promoted as facts. There is no evidence that Foundation status in itself will lead to the trust “focus(ing) on the needs of patients and our local population”. As far as the view of GMB is concerned Foundation status will mean that the priority of the trust will be financial rather than service based.

The consultation document certainly outlines the perceived benefits of this financial independence, however nothing is mentioned of some of the downsides to this. The Healthcare Commission found that being financially independent also carried risks for trusts, particularly with regards to introducing other policies and initiatives for example Payment by results caused Foundation Trusts serious organisational and financial difficulties.

There is continuing concern that by gaining financial freedom from National government the trust also looses the financial security which comes with that structure. The issue of what would happen where a Foundation Trust to become bankrupt has never been resolved and the potential impact on the national NHS is an unknown quantity.

Foundation status will also give us more business and commercial opportunities to offer services in new and innovative ways.”

However the Guardian Dec 2004 survey of Chief Executives of Foundation Trusts found that the Chief Execs found themselves “tied up in red tape and denied the commercial flexibility they needed to prosper.”

Will there be better healthcare as a consequence of becoming a Foundation Trust?

The answer in the consultation document to this is evasive. However the Healthcare commission report Dec 2005 stated one of its findings “We did not find significant differences so far on readily available indicators of quality of and access to care between NHS foundation trusts as a whole group and other acute NHS Trusts.”

From national surveys of patients and staff, the Healthcare Commission found that “no significant differences were found between NHS Foundation Trusts and NHS Trusts in relation to experiences of patients, the attitude of staff and provision of care.”

Comments on the Consultation issues:

Although the GMB continue to be opposed to any NHS Trust becoming a Foundation trust we feel it is necessary to comment on the consultation as it is likely to be our only opportunity to do so.

Council of Governors

We believe that the proposal for only 3 staff governors on the Council of Governors is inadequate. The average quoted in the Healthcare Commission report in 2005 was of 5 staff governors. The current proposals are the legal minimum of staff reps allowed on the Council of Governors. The GMB believes that there should be maximum representation of staff on the Council of Governors (some trusts have up to 7). There is evidence to suggest that staff governors are invaluable to the Council of Governors in other trusts. Surrounded by evidence that often newly appointed governors find the role challenging, it is difficult to have influence and have poor training and support the Healthcare Commission found that “(staff governors) seemed to have an advantage over other governors due to a better understanding of the organisation and as members of staff working in the trust they have existing channels of communication to build on.”

It would also be preferable for there to be both representations of clinical and non clinical staff as staff governors to ensure it is not certain members of staff from certain backgrounds and experiences that are represented. There is no mention of this in the consultation document.

Staff involvement/impact on staff

So far as the staff are concerned your failure to commit to maintain NHS wages and conditions of service is an obvious worry. Since you will be able to hold onto ‘surpluses’ then inevitably you will be seeking to cut costs in order to maximise surpluses, and this will impact on staff as well as the work you do. The threat to hard won national terms and conditions for our members working at the trust is a big concern. The fact that national terms and conditions existing and future are not safeguarded for staff , the only comment made is that there are ‘no plans to change them yet’, does not reassure employees.

There is very little detail on how staff will be involved in the Foundation Trust in comparison to the other groups which are being engaged (local people and partners). Although the document states that staff governors will be included in the decisions regarding the strategic direction of the trust, the document fails to cover staff in anymore detail.

It is a requirement prior to recommendation from the Minister for the trust to develop an HR strategy to take them into and beyond transition to Foundation trust. This should be done in partnership with the staff/recognised trade unions. To date this has not happened within Swindon and Marlborough Trust. As a vitally important document for such a wide ranging change this document and preparation along with consultation with the unions regarding this issue should have begun some time ago. GMB has serious concerns that without this preparation the transition to Foundation Trust would be hugely problematic.

Board of Directors

There appears to be no representation of non clinical staff in the proposed make up of the Board of Directors. This would be vital to get a fair representation of the employees involved in service provision within the trust, especially as the majority of staff working within the hospital are non clinical staff.

Consultation on the change of the Trusts name

Ironically this appears to be the only thing that we are actually being fully consulted on.

The GMB consider this decision to be insignificant in comparison with the other issues relating to the possible move to Foundation status. The very requirement to change the name of the trust seems to demonstrate unnecessary bureaucracy and cost which would be better spent elsewhere.

General Points

The timescales are a concern, bearing in mind a decision could be made very quickly following the end of this consultation and we do not believe that the staff, patients or local people have had the opportunity to decide about whether Foundation status is the right decision for their local trust, let alone the detail of how a foundation trust should be run.

Finally, the Trust says that it is making the application because it has been instructed to do so by the government. Whilst it is certainly the aspiration of the government for all Trusts to become Foundation Trusts we can find nothing to show that all trusts are ‘instructed’ to make applications. The government has spoken of giving them all ‘the opportunity’ to do so. There are in fact only 73 Trusts so far that have become Foundations.

We can only conclude therefore that the Trust is making the application because it wants to gain the ‘freedoms’ this gives them. It is therefore supporting the government’s dismantling of the NHS rather than merely following instructions.

For all these reasons we are opposed to the application which is neither in the interests of staff nor service users.

Yours sincerely,

Michelle Gordon

Secretary, Wiltshire & Swindon GMB

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