5 Conclusions |
112. FTs have some proven strengths,
but much is unknown. In general, robust evidence is lacking. It
is not clear whether their high performance in terms of finance
and quality 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, but, again, there is a lack of objective evidence
about what improvements, if any, FTs have produced.
113. The lack of objective evidence
about, and evaluation of, FTs' performance is surprising given
the importance of this policy. With over half of NHS trusts now
FTs, the time is right to begin systematic and independent evaluation.
The Department of Health should, as a priority, commission research
to assess FTs' performance objectively. This will require access
to FT data. Researchers have found it difficult to access such
data. This should be centrally collected by Monitor and published.
114. It seems that many fears
about FTs' impact on local health economies have not been borne
out; however, they have made little contribution towards the government's
aim of delivering more NHS care outside hospitals with the interesting
exception of mental health trusts. This is not solely attributable
to FTs themselves; rather it is a consequence of payment by results
and inadequate collaboration between PCTs and FTs, notably their
failure to reduce emergency admissions to hospitals.
115. In this inquiry the deficiencies
of PCTs were also seen as contributing to other failings. In particular,
FTs' slowness to innovate and invest was seen as a failure on
the part of PCTs to provide strategic guidance. The Government
is clearly aware of these deficiencies and has announced plans
to strengthen PCTs' commissioning skills through its World
Class Commissioning programme; however, it is unfortunate
that this has come after the establishment of FTs and not before.
116. A major advantage of FT
status is the autonomy it gives trusts. While FTs do not appear
to have yet exploited the full potential of their autonomy, witnesses
from FTs argued that the ability to make decisions more quickly
was important and made a 'tangible' difference to the dynamic
of their organisations, which we welcome. Unfortunately, there
are persisting concerns about what level of government intervention
in FTs' affairs is legitimate. We recommend that the Government
clarify what the appropriate levels of intervention are.
117. FTs' use of their autonomy
and the relationship between FTs, their regulator, and Government
should be included in the Department of Health's evaluation of
FTs' progress which we have recommend above.
118. 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'