Health Committee reckons ‘FTs have some proven strengths, but much is unknown’

The House of Commons Health Committee has published a short report on Foundation Trusts (FTs) and Monitor.

The report finds that FTs have some proven strengths. They have performed well financially and generated surpluses. They have been high performers in routine NHS process quality measures. However, much is unknown. With a lack of objective evidence, it is not clear whether their high-performance is the result of their changed status, or simply a continuation of long term trends, since the best trusts have become FTs.

Key aims of FTs were the promotion of innovation and greater public involvement. While the Committee was provided with examples of good practice in both of these areas, again there was a lack of
objective evidence. 

In relation to public involvement, while the Committee saw some examples of good practice in FTs’ new governance arrangements, in general they seem to be slow to deliver benefits and despite numerous small studies, there remains a lack of robust evidence of their effectiveness. The governance process currently costs circa £200,000 per trust, giving a total of around £20 million per annum. We recommend that the Department of Health make it a priority to evaluate rigorously the FT governance system and to give guidance on best practice so that public money as well as members’ and governors’ time can be used as effectively as possible to improve services.

The Committee also found that while FTs do not appear to have yet exploited the full potential of their autonomy, witnesses from FTs told them that the ability of boards to make decisions more quickly was important and made a ‘tangible’ difference to the dynamic of their organisations. Unfortunately, concerns persist about what level of Government intervention in FTs’ affairs is legitimate, and the Government must clarify what the appropriate levels of intervention are.

Finally, the Committee found that Monitor’s application process and regulatory regime seems to be well regarded. However, a complex regulatory environment of other organisations also surrounds FTs, and in particular there is potential duplication between the Healthcare Commission and Monitor both of which evaluate the quality of FTs’ services.

Download the Health Committee report Foundation trusts and Monitor here.

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