Today I am at the Convention Centre in Liverpool for the first ever Foundation Trust Network national conference. I’m on the platform on a couple of panels to talk about quality and regulation (of which more later).
It’s interesting that after eight years this is the first ever FT Network conference. Structurally there is a difficult relationship between Foundation Trusts and the rest of the NHS Confederation family. In the same way the Confederation will have a different relationship with the clinical commissioning groups than it did with the PCTs. Both of these sets of organisations, FTs and CCGs have been created to be different from previous NHS institutions.
From 2004 the difference was always clear for provider trusts. Non FTs are owned by the Secretary of State while FTs are owned by the FT Board. The transition from non-FT to FT is much more than a simple change of title. For the FT Board it is a radical change in the level of responsibility. That’s why most of the “testing” that trusts wanting to become FTs have to go through is to test the capability of their board to take the responsibility of not being owned by the Secretary of State.
Until now that responsibility of ownership by the Secretary of State has, for non-FTs, been carried out on their behalf by the Strategic Health Authorities. From April 1st next year that responsibility will fall to the NHS Trust Development Agency. Both of these organisations – old and new – have taken their role as owners of non FTs seriously.
One of the main questions asked about NHS architecture, post the creation of the first FT in 2004, has been why FTs have not all been much more separate from the NHS hierarchy. Throughout the period the SHAs have usually been trying to tell FTs how to operate as a part of the wider NHS – and sometimes that has been intrusive. Why haven’t more FTs told the SHAs where to get off?
Over the last few years I have spent time with CEOs, Chairs and Board members of FTs and amongst some of them there has been a lack of trust that their status is really permanent. They believe that the NHS hierarchy has only temporarily taken its hands off of them and that at some date in the near future, they will be taken back and retribution for any overly independent behaviour will take place.
This is an important example of how strong the dominant NHS culture really is. There was a law which challenged the ownership of FTs and it was passed. For eight years they have had experience of being a different legal entity. But the belief that the old hierarchy will have its way and punish any autonomous behaviour is still strong.
The two panels on which I am speaking today are both concerned with this issue. How do FTs develop their own drive for quality and safety if the CQC see this as their job? How do FTs develop their own approach to risk if Monitor sees that as their job?
The two Davids, Behan and Bennett, will talk before each panel and I am sure they will both clearly say that the responsibility for both the activities of quality and risk lies with the FTs and their boards.
But what is significant is that many Boards believe that both regulators do not allow them to take that responsibility. Many FT boards would argue that the behaviour of some staff in both regulators leave the Boards with little doubt that the FT is being surrounded by the regulator and not run by the Board.
I will report on the discussions in a post tomorrow.