59. Evidence submitted by Monitor (PPI
118)
EXECUTIVE SUMMARY
1. There are currently 54 NHS foundation
trusts which have around 625,000 members drawn from the public,
patients and staff. The patient and public members elect the majority
of the Board of Governors of each NHS foundation trust.
2. The numbers involved, and the degree
of engagement which is taking place, indicate that membership
is providing an effective route by which patients and public can
engage with their local NHS foundation trust.
3. The governance structure of NHS foundation
trusts has brought a new dimension to patient and public involvement
in the NHS. The right to elect governors, who have specific powers
in relation to the trust, ensures that members have a specific
role in the governance structure of an NHS foundation trust. This
is a distinct position from other patient and public involvement
initiatives in the NHS.
4. The 54 NHS foundation trusts have around
930 patient and public governors. The boards of governors have
been working effectively with the boards of directors, for example
liaising on appointments of non-executive directors and overseeing
the development of strategy. In Monitor's view it is as yet too
early to say whether governors will be able to have the necessary
blend of experience, skills and influence to successfully shape
the long term strategy of each NHS foundation trust.
5. The number of NHS foundation trusts will
grow steadily over the next two years. This will ensure that the
membership concept is firmly established in the majority of acute
and mental health trusts and, through the planned creation of
community foundation trusts, in primary care settings too.
6. Where patient and public involvement
initiatives overlap there is potential for confusion as to the
different responsibilities of each organisation. It is therefore
essential that the development of the new Local Involvement Networks
avoids any duplication with the responsibilities of the governors
of NHS foundation trusts.
MONITOR AND
NHS FOUNDATION TRUSTS
7. Monitor's statutory name is the Independent
Regulator of NHS Foundation Trusts. Monitor was established in
January 2004 under the Health and Social Care (Community Health
and Standards) Act 2003. Monitor's statutory responsibilities
include the authorisation and regulation of NHS foundation trusts.
Monitor is independent of the Department of Health. It is accountable
to Parliament.
8. NHS foundation trusts are autonomous
organisations. They are no longer subject to direction by the
Secretary of State for Health, although they must continue to
work within the framework of national targets and standards established
by the Secretary of State. Their primary purpose must remain the
provision of services to the NHS.
9. The Board of Directors of each NHS foundation
trust is responsible for strategy and performance. They are accountable
to local members through the Board of Governors.
10. There are now 54 NHS foundation trusts,
including five mental health trusts. Their annualised total income
is around £10.8 billion (based on 2005-06 figures), accounting
for over a quarter of acute trust activity in England.
MEMBERS AND
GOVERNORS
11. Each NHS foundation trust has public
members drawn from their local population and staff members; it
may also have patient members. Members can elect representatives
to the FT's Board of Governors. A majority of the governors must
be elected by patient and public members. The Board of Governors
has a number of statutory powers including:
appointing or removing the chair
and non-executive directors;
approving the appointment of the
chief executive;
appointing the auditors of the trust;
and
considering the trust's annual forward
plan.
12. The 54 NHS foundation trusts have around
625,000 memberssee table at Annex A. Around 75% of members
are from the patient and public constituencies. There are around
930 patient and public governors. A governor profile for a recently
authorised NHS foundation trust is shown at Annex B.
13. Membership provides an effective way
of engaging with the local community. All NHS foundation trusts
are required to take steps to secure membership which is representative
of the communities they serve. The plans received for 2006-07
showed NHS foundation trusts undertaking a variety of activities
to engage effectively with their members including:
Leaflets and letters to constituency
members.
Targetted letters to local groups
or local authorities.
Seminar and lecture programmes.
Surveys and questionnaires.
Membership stands at local events.
Articles in local media.
The two examples in paragraphs 14 and 15 illustrate
the type of engagement that NHS foundation trusts have had with
members.
14. Cambridge University Hospitals NHS foundation
trust has one of the largest memberships. Governors have taken
responsibility for communicating with members with monthly meetings
held in local towns and villages. Meetings take place both in
afternoons and evenings to make them more accessible to any member
wishing to attend. The trust identified that giving the meeting
a theme will increase attendance and so the local member meetings
have incorporated topical themes such as the role of the modern
matron and hospital food.
15. Chesterfield Royal Hospital NHS Foundation
Trust consulted public and staff members on new proposals to change
visiting hours at the hospital. As part of plans to reduce hospital
-acquired infection, members were asked if visiting hours should
be reduced. In exchange more cleaning would take place on wards
and a new visitors' code would be adoptedincluding a ban
on more than two patients per bedside. Almost 5,000 responses
were received (nearly 50% of the membership). Over 96% were in
favour of the new code. However the trust was asked to extend
afternoon visiting from a proposed one hour, to a two hour slotto
help visitors travelling long distances. The trust agreed to this
change. The consultation led to major changes in the way the hospital
operates being implemented with total support from staff, patients
and local people.
16. Members' statutory influence over the
NHS foundation trusts comes through the election of governors.
Participation rates in elections have averaged around 35% within
the public constituency.
17. Monitor is satisfied that across all
NHS foundation trusts governors have been carrying out their formal
roles in an effective manner, making sound appointments to non-executive
director posts, appointing auditors rigorously and overseeing
the activities of the organisation effectively.
18. There have to date been no significant
cases in which governors have come into conflict with boards of
directors. This is to be welcome if it indicates that NHS foundation
trusts are running themselves effectively. However, it may suggest
that governors have not yet sufficiently found their feet. Monitor
welcomes the proposal to establish a governors' forum, to be run
by the King's Fund, which will provide a focus for governors to
share information and learning. There will no doubt be challenges
and changes ahead for many NHS foundation trusts and governors
need to ensure that they are properly engaged in giving oversight
to their organisations if local accountability is to have real
force.
19. In 2006 Monitor published the NHS Foundation
Trust Code of Governance. This sets out a best practice framework
for the corporate governance of NHS foundation trusts, drawing
on experience from the private and public sector. In consulting
on the Code many respondents suggested that Monitor should provide
further guidance on the role of governors. At present Monitor
has plans to undertake further work in 2007 on the role of governors
and will consider whether it would be helpful to issue further
best practice advice on the governors' role.
Monitor
10 January 2007
Annex A
TABLE OF MEMBERSHIP
NHS FOUNDATION TRUSTS
AUTHORISED AS
AT 31 MARCH
2006
NHS foundation trust
| Total
membership
as at 31/3/06
|
Barnsley | 12,602 |
Basildon and Thurrock | 12,069
|
Bradford Teaching | 4,221 |
Cambridge University Hospitals | 23,597
|
Chesterfield Royal | 13,346
|
City Hospitals Sunderland | 9,129
|
Countess of Chester | 4,266
|
Derby Hospitals | 13,994 |
Doncaster and Bassetlaw | 7,870
|
Frimley Park | 7,671 |
Gateshead Health | 11,171 |
Gloucestershire Hospitals | 14,609
|
Guy's and St Thomas' | 13,368
|
Harrogate and District | 13,557
|
Heart of England | 51,038 |
Homerton University | 5,968
|
Lancashire Teaching | 14,592
|
Liverpool Women's | 10,693 |
Moorfields | 11,487 |
Papworth | 11,690 |
Peterborough | 8,523 |
Queen Victoria Hospital | 13,031
|
Royal National Hospital for Rheumatic Diseases
| 4,612 |
Sheffield Teaching | 18,168
|
South Tyneside | 4,963 |
Stockport NHS | 11,938 |
The Rotherham | 5,502 |
The Royal Bournemouth and Christchurch |
14,990 |
Royal Devon and Exeter | 15,600
|
The Royal Marsden | 4,893 |
University College London Hospitals | 10,194
|
University Hospital Birmingham | 91,961
|
TOTAL | 471,313 |
TRUSTS AUTHORISED
IN 2006
Name | Members
|
Oxleas | 4,056 |
South Essex | 8,039 |
South Staffordshire | 5,026
|
Royal Berkshire | 10,173 |
Salisbury | 9,209 |
Southend | 13,200 |
Newcastle | 8,678 |
Yeovil | 5,390 |
Aintree | 6,398 |
Calderdale | 2,364 |
Clatterbridge | 4,179 |
James Paget | 12,965 |
Luton & Dunstable | 8,336
|
Northumbria | 11,031 |
Salford | 8,008 |
Sheffield Childrens | 3,274
|
Chelsea and West. | 10,914 |
Tavistock and Port. | 2,300
|
South Manchester | 9,142 |
SL and Maudsley | 2,361 |
North Hampshire | 4,037 |
Kings | 7,407 |
Sub-total | 156,487 |
TOTAL all trusts | 627,800 |
Notes:
1. Membership figures for the first 32 NHS foundation
trusts are as at 31 March 2006 as reported to Monitor in Annual
Plans for 2006-07.
2. For trusts authorised in 2006, membership figures
are as at date of authorisation.
Annex B
GOVERNANCE STRUCTURE
TYPICAL STRUCTURE
OF AN
NHS FOUNDATION TRUST
BOARD OF
GOVERNORS
20 patient and public governors
3 Area A
5 Area B
4 Area C
2 Area D
1 Area E
5 Patients' constituency
12 appointed governors
2 PCTs
1 University
2 Primary care clinicians
2 Local authority
1 PFI partner
1 Chamber of commerce
1 PPI forum
1 Local regeneration project
1 Voluntary sector
7 staff governors
1 Medical and dental practitioners
2 Nursing and midwifery
1 Other clinical staff
1 Non-clinical staff
1 PFI staff
1 Volunteer
Based on constitution of University Hospital of South Manchester
NHS Foundation Trust
|