Select Committee on Health Sixth Report

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' services.

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