Memorandum by Bradford Teaching Hospitals
NHS Trust
FOUNDATION TRUSTS—AN OPPORTUNITY FOR
BRADFORD (FT 20)
This memorandum has been prepared at the request
of the Health Committee Secretariat for the evidence session scheduled
for 6 February 2003. It has been prepared by David Jackson LLB,
FIHM, JP, who has been Chief Executive of Bradford Hospitals NHS
Trust since 1 March 1992. He is a career NHS Manager who joined
the NHS as a graduate management trainee in 1970 and has held
top posts in East Yorkshire, Grimsby, Leeds and Bradford. Bradford
Hospitals is a major acute hospitals trust serving Bradford and,
for more specialist services, significant parts of West Yorkshire.
It has been awarded 3 stars for 2 successive years in the NHS
performance ratings, and became a Teaching Hospital in January
2003 in association with the Leeds Medical School.
1. INTRODUCTION
The Board of Bradford Teaching Hospitals NHS
has unanimously resolved to submit a preliminary application to
become a Foundation Trust because we believe, on the information
currently available, that the Foundation Trust model promises
to help us to provide better services for patients, greater opportunities
for staff, more dynamic and responsive relations with our partners
in health, education, social services and the voluntary sector
and a bigger contribution to the well being of the local community,
whilst remaining firmly within the framework of the NHS. We intend
to closely monitor the development of the concept of Foundation
Hospitals through the legislative process and, provided we remain
satisfied that becoming a Foundation Trust will realise this promise,
we will submit a second stage application if invited to do so.
2. WHY APPLY
TO BECOME
A FOUNDATION
TRUST?
Bradford Teaching Hospitals NHS Trust has a
track record of delivering, demonstrated by its success in developing
high quality patient services and reflected in its consistent
3 star rating. We enjoy excellent relationships within the Bradford
health community and as one of the national pilot sites for Pursuing
Perfection we have a recognised organisational culture which strives
for continual innovation and improvement. This makes us a natural
contender to be a Foundation Trust and all that that entails.
We believe that becoming a Foundation Trust
will help Bradford Teaching Hospitals to achieve its vision and
accelerate improved patient services. The vision is first and
foremost to excel in delivering the diagnosis, treatment and care
for our patients, but we recognise that to achieve that purpose
we must also meet the expectations of our patients, public, staff
and partners if we are to remain the hospital of first choice
for the community we serve. This means being flexible and responsive
to all our stakeholders, delivering targets and achieving
clinical excellence and patient satisfaction.
Being a Foundation NHS Trust status offers a
very exciting opportunity to unleash local innovation and entrepreneurial
flair, adding further momentum to our "can do" culture
which is symbiotic with the local health economy. The freedoms
and benefits will enable us to innovate in service delivery and
asset use, and incentivise to exceed national performance targets.
Whilst we see considerable benefits from the
model of devolved ownership and decision making, we are deeply
committed and believe that our patients, staff and partners are
equally committed to remaining within the NHS framework of values
and the national standards. Becoming a Foundation Trust is the
next logical step for a progressive and successful secondary care
organisation like Bradford Teaching Hospitals and it provides
a platform to achieve dramatic improvements in patient care.
3. SOCIAL OWNERSHIP
AND COMMUNITY
REGENERATION
One of the main attractions of becoming a Foundation
Trust is the model of social ownership for local health services
which replaces central government control. The local accountability
framework underpinning Foundation Trusts facilitates a much more
meaningful degree of integration with the local community than
has been possible hitherto and helps to achieve the objective
of binding NHS hospitals closer to the communities they serve.
Bradford Teaching Hospitals are integral to
the life of Bradford and make a significant contribution to the
health and social well being of the local community. We see becoming
a Foundation Trust as a way of ensuring that the people of Bradford
(whether because they are patients, carers, staff, partner organisations
or simply interested in the well being of our hospitals) can contribute
to the Trust's success through this new form of social ownership.
The Bradford "membership community" will own and control
their NHS Foundation Trust and take decisions about its future.
Such local decision making is pivotal to creating more locally
responsive services.
We serve one of the poorest communities in England
with consequential high levels of morbidity. Bradford is a very
distinct community when compared to the rest of the country and
our health services need more flexibility to respond appropriately
to the communities distinct and diverse needs. We believe that
becoming a Foundation Trust would not only facilitate flexible
service provision, but also would add considerable momentum to
the process of economic and social neighbourhood renewal currently
under way. It provides an opportunity for Bradford Teaching Hospitals
to contribute to the whole community in a more direct and meaningful
way by playing a greater role in promoting social cohesion and
integrating with the wider regeneration of Bradford and its local
economy.
4. ACCOUNTABILITY
We welcome the accountability framework for
Foundation Trusts with its emphasis on regulation and direct accountability
to patients, public and partners rather than bureaucratic control.
The freedom from top down centralised and oppressive bureaucracy
that inhibits local innovation and diverts management focus will
release the enthusiasm for innovation of our professional staff
who will experience fewer prescriptive central demands, guidance
and reporting arrangements. Instead we will be accountable through
a transparent and local democratic process rather than line management
from Whitehall, whilst the service commissioning process will
ensure the continuation of NHS control.
5. GOVERNANCE
An elected Board of Governors on which local
people have an absolute majority is pivotal to the framework of
increased local accountability. Local people will elect over half
of the members of the Board of Governors. They will be joined
by elected staff members and other governors from our partner
organisations, such as the Primary Care Trusts, the Local Authority,
the Medical School, Bradford University and others. Actual membership
of the Board of Governors will be subject to discussion, should
the Trust be selected to proceed to a second stage application.
Because of the nature of the Bradford community, we anticipate
widespread interest in membership of the Foundation Trust and
we will aim for at least 10,000 members.
We are committed to ensuring that the people
of Bradford feel included in both the ownership and governance
of the Foundation Trust, should we proceed. How to achieve this
will be an important dimension of local discussions.
The Board of Governors will appoint a Strategic
Management Board, who, much like the current Trust Board, will
be responsible for the strategic leadership of the organisation
and will hold the Executive Directors to account. The Chief Executive
will remain the Accountable Officer both to the Board and to Parliament.
6. IMPLICATIONS
FOR STAFF
Becoming a Foundation Trust will preserve all
the benefits of NHS employment with protected staff contracts
and terms and conditions such as continuous NHS service, pension
entitlements and access to NHS training and education. It will
commit Bradford Teaching Hospitals to being an early implementor
of Agenda for Change with the promise of additional finance and
other assistance to accelerate the introduction of model employment
practices and pay modernisation. In addition, in recognition of
their hard work and commitment, the Foundation Trust will retain
the freedom to offer additional performance related rewards to
staff linked to our success as a health care organisation.
Staff are a keen and scarce resource within
the health care sector and there has always been an element of
competition in recruitment. Hospitals have had to react to the
emphasis on Primary Care, the emergence of choice and diversity
within the health care sector and the success of the economy generally
by promoting their attractions as good employers and good places
to work. This will continue and NHS Trusts have considerable flexibility
to differentiate as an aid to recruitment but this has and always
will be limited by financial reality. On the whole NHS Trusts
in West Yorkshire have not engaged in inflationary recruitment
practices because it is not in their interests or the interests
of their commissioners to do so. With national tariff prices there
will be even less scope to engage in inflationary recruitment
and competition for staff will be even more focused on "soft"
factors. In this Foundation Trusts will have the benefit of their
reputations as high performing institutions in the same way that
teaching hospitals, tertiary centres and 3 star hospitals as better
able to recruit staff who are attracted by these features. Other
hospitals in the local health economy will have their own unique
features to aid recruitment.
7. FINANCIAL
FLEXIBILITY
The financial flexibilities and local autonomy
underpinning Foundation Trusts will enable Bradford Hospitals
to take a longer term view of service development and avoid the
short term consequences of the current system which hinders service
improvement. For example, the more flexibile access to capital
will allow us to develop our services and facilities when the
need arises on the basis of business decisions. Currently the
imperative to expand capacity to meet access targets is frustrated
by the physical limitations affecting our diagnostic and treatment
facilities and the near impossibility of accessing capital. This
process is excessively bureaucratic for relatively trivial levels
of funding. As a Foundation Trust we would be able to enter into
joint ventures with other organisations (for example via public
private partnership agreements) to expedite capital investment
in improving diagnostic and treatment facilities.
8. IMPACT ON
THE WIDER
HEALTH ECONOMY
Foundation Trust status will have a considerable
and beneficial impact upon the local health economy:
— It will strengthen local partnerships
- for example, via the involvement of PCT and university representatives
on the Board of Governors, giving partner organisations a real
stake in the success of the hospitals.
— It will facilitate more locally tailored
health services within the National Service Frameworks
— It will stimulate innovation, encouraging
the local health economy to improve services for Bradford residents.
— It will deliver more transparent
relationships with NHS commissioning organisations and providers.
There would be greater clarity over funding streams and what they
are used for.
— It will change the dynamics of commissioning.
As a Foundation Trust, we will not be subject to performance management
by the Department of Health or Strategic Health Authorities. Instead
we will be held to account for delivering outputs and ultimately
outcomes for the NHS agreed with PCTs and other partners in the
health economy. Our funding will be based on payment results.
— It will create a more stable environment
for the local health economy. PCTs will use their budgets to enter
into three year legally binding service agreements which will
provide both service and financial stability.
— It will enhance Bradford's academic
and teaching hospital status by widening opportunities for research
and collaboration with R & D organisations.
Whilst these benefits flow from the freedom
from central and bureaucratic control, Foundation Trusts will
nevertheless operate within a very clear accountability framework
of regulation and local social ownership. For all practical purposes
a Foundation Trust's entire income will come from Primary Care
Trusts and other NHS Commissioners and it will be contestable
in the sense that there are other providers to whom service contracts
can be transferred. Therefore to secure its future, a Foundation
Trust must meet its NHS Commissioners' expectations in terms of
service delivery, including cost which in the mid term will be
based on national tariff prices. Through this simple mechanism,
the NHS will retain ultimate control of Foundation Trusts, whilst
achieving sufficient flexibility for the benefits to be realised.
CONCLUSION
Foundation Trusts are designed to enhance the
relationship between NHS hospitals and the communities they serve
and within a new model of local social ownership to unleash local
innovation and entrepreneurism, via the principle of "earned
autonomy". We see considerable benefits from the model of
devolved decision-making inherent to the concept, which could
be a potent force to improving both health services and social
cohesion for the people of Bradford.
January 2003
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