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Foundation Hospitals a UNISON branch guide August 2003
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CONTENTS What are foundation hospitals?
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Who can become a foundation hospital?
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Why UNISON is opposed to foundation hospitals
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Frequently asked questions
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What is UNISON seeking to achieve?
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Branch campaigns
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Appendix A Overview and scrutiny committee
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FOUNDATION HOSPITALS — a UNISON branch guide 2003
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WHAT ARE FOUNDATION HOSPITALS? Foundation hospitals are a new form of hospital being introduced by the government as part of its programme of reforms in the NHS. They will be independent legal entities, and will be owned by their members who will include patients, staff and local people. Foundation hospitals will be granted a licence to operate by an independent regulator and will not be under government control. Foundation hospitals will have greater powers and flexibilities than traditional NHS hospitals. In particular they will be able to: ● borrow from the private sector ● retain their surpluses ● keep hold of all money from the sale of land and assets ● exercise a greater degree of discretion on pay than other NHS hospitals. Foundation hospitals will be controlled by a board of governors who will be elected annually by their members. UNISON is concerned that foundation hospitals are part of a process of marketisation in the NHS, involving the reintroduction of competition and an increased role for the private sector. We believe that this will undermine the public service principles of the NHS, leading to poorer and more unequal services and the extension of charging.
WHO CAN BECOME A FOUNDATION HOSPITAL? Only NHS trusts that have three stars under the government’s star rating system are currently eligible to apply for foundation hospital status. However, the government has said that it hopes that over the next four to five years all NHS trusts will become foundation hospitals. This may mean that the Government plans in future to open foundation status to hospitals with less than a three star rating. As well as NHS hospitals, the legislation introducing foundation hospitals gives the government scope to open up eligibility for foundation status to other types of organisation. The government claims that this is to give the option of opening foundation status to voluntary sector organisations such as hospices. However, the bill would also allow the government to permit applications for foundation status from private companies, such as perhaps BUPA or Boots. Such private companies acquiring foundation status would not be subject to the cap on private work, as this applies only to former NHS hospitals. However, in common with other NHS hospitals, they would be exempt from corporation tax. It remains to be seen if any private sector companies will show an interest in foundation status.
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WHY UNISON IS OPPOSED TO FOUNDATION HOSPITALS Reason 1: Foundation hospitals will compete as part of a commercial market Foundation hospitals will operate in a competitive, commercial market in the NHS. In this market primary care trusts (PCTs) will buy services from a range of different providers across the public and private sectors, including NHS Trusts, Foundation hospitals and the government’s new, privately run diagnostic and treatment centres. Foundation hospitals will have greater access to funds to invest in services and health facilities than other hospitals giving them an unfair advantage over non-foundation hospitals. UNISON is concerned that competition from foundation hospitals undermine other hospitals, forcing them to close services and leading to the creation of a two-tier health service. Reason 2: Foundation hospitals will be a backdoor to privatisation Foundation hospitals status will create a backdoor to privatisation by allowing private organisations, such as BUPA, to apply for a licence to run a foundation hospital. UNISON is concerned that foundation hospitals will provide a further opportunity for private sector interest and private sector profits to make inroads into the NHS. Reason 3: Foundation hospitals will not lead to greater local accountability or social ownership NHS hospitals are already owned by and run for the benefit of the whole public. The governance framework for foundation hospitals will not lead to greater local accountability or social ownership. At the same time, foundation hospitals will no longer be answerable to the secretary of state for health, with responsibility for them moving to an independent regulator. UNISON is concerned that foundation hospitals will not represent the communities they serve. Reason 4: Foundation hospitals will be poor value for money Foundation hospitals will have freedoms to borrow privately which costs more than if they borrowed from the public sector. However, overall spending limits for the NHS will stay the same. UNISON is concerned that public finance will simply be replaced by more expensive private finance, leading to higher costs and no overall increase in the level of NHS capital investment. Reason 5: Foundation hospitals will lead to greater inequalities between hospitals Foundation hospitals will have greater powers and freedoms than NHS hospitals leading to greater inequalities in the health service. For example, they will be able to keep all operating surpluses and asset sale proceeds themselves, whereas under the current system, surpluses go to a central NHS funding pool from where they are redistributed to wherever the need in the NHS is the greatest. UNISON is concerned that foundation hospitals will prevent resources from land and asset sales being redistributed around the NHS according to need. Reason 6: Foundation hospitals will draw scarce staff away from non-foundation trusts Foundation hospitals will have greater flexibilities than other hospitals to set pay, enabling them to draw scarce staff away from trusts that do not have foundation status.
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UNISON is concerned that trusts without foundation status will have difficulty recruiting and retaining staff. This will undermine their performance and increase their reliance on temporary staff. Reason 7: Foundation hospitals will undermine the NHS’s public service principles Foundation hospitals will undermine the provision of an integrated and planned health service and will reinforce inequalities in access to health care. They will have an extremely negative impact on the NHS and staff as there is an emphasis on meeting financial needs rather than health needs. UNISON is concerned that foundation hospitals will encourage hospitals to work against each other and not in the best interests of patients. A full report of “The seven reasons why UNISON is opposed to foundation trusts” is available from the UNISON website: www.unison.org.uk/foundation
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FREQUENTLY ASKED QUESTIONS Will foundation hospitals compete as part of a commercial market? Foundation hospitals will contribute towards the introduction of a new competitive commercial market into the NHS. Under this market, primary care trusts will commission services from a range of different providers across the public and private sectors, including NHS hospitals, foundation hospitals and privately run diagnostic and treatment centres. Providers will compete against each other for business, with funding following the patient. Very similar in fact to the discredited internal market that Labour was elected to end. UNISON is concerned that competition from foundation hospitals will lead to financial instability for other NHS Hospitals. Relatively small changes in patient demand could destabilise smaller general hospitals, forcing them to close services in order to remain financially viable. Non-foundation hospitals will be at an unfair disadvantage in competing for patients. Foundation hospitals will be in a better position than NHS hospitals to compete because of their additional financial freedoms, for example by borrowing from the private sector to invest in new services or to upgrade facilities. Will foundation hospitals be a backdoor to privatisation? The government’s proposed legislation will allow not only existing NHS hospitals to become foundation hospitals, but also other organisations from the private or voluntary sectors. There is nothing in principle to stop an organisation such as BUPA from being awarded a licence to run a foundation hospital. Foundation hospitals will also lead to greater privatisation because there will be nothing to stop NHS hospitals that gain foundation status from outsourcing some or all of their functions to the private sector. Will foundation hospitals undermine the NHS’s public service principles Foundation hospitals will undermine the NHS’s public services principles and conflict with other, more positive, government reforms. Some of the ways in which this will happen include: Healthcare planning and the provision of joined-up services: Foundation hospitals will jeopardise the success of the government’s initiatives to improve the way in which NHS organisations plan services together and to provide a joined-up healthcare service for patients. Foundation hospitals will strengthen institutional boundaries, making it more difficult to ensure that patients moving around the NHS receive an integrated package of care. Furthermore, the independent status of foundation hospitals will undermine the ability of the NHS to take a planned and coordinated approach to service development, allowing foundation hospitals to duplicate existing services or to ignore local health needs. Equality of access: One of the guiding principles underpinning the NHS is that it should be accessible to all who need it on a equal basis, regardless of factors such as age or complexity of treatment. This could be compromised by foundation hospitals, which according to the government’s guidance will be required only to meet a ‘reasonable level of demand’ for regulated services listed in the licence. Where demand exceeds this level, foundation hospitals may therefore be able to exercise selectivity in deciding whom to treat, rejecting those patients with higher than average costs and focusing on those individuals from whom they will make the most profit.
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Best practice sharing: Foundation hospitals would undermine the government’s attempt to promote better sharing of good practice and innovation across the NHS. Foundation hospitals will take many of the best NHS hospitals out of the mainstream of the NHS and will make hospitals more reluctant to share good practice by encouraging greater competition between hospitals. The government claims that the principles and ethos of the NHS will be protected by the independent regulator for foundation hospitals, which will issue foundation hospitals with their licences, deal with any breaches and adjudicate on proposed changes to foundation hospitals’ regulated services. This, however, provides little comfort as the Government has failed to provide any clarification regarding what principles or criteria by which the independent regulator will be expected to observe in making its decisions. Thus, for example, it is unclear whether the independent regulator will be obliged to have regard to the universal coverage of the NHS or the principle of equality of access to NHS care. Will foundation hospitals be able to vary the range of services they provide? Each foundation hospital’s licence will specify which services it is required to provide as a condition of its authorisation. This list will initially mirror the clinical services provided by the foundation hospital at the time of its establishment. If a foundation hospital wants to substantially vary the services listed in its licence it will be required to consult with the public, primary care trusts and the local authority’s overview and scrutiny committee. Having consulted, the foundation hospital will then be required to submit its proposed changes to the independent regulator, who will check that the correct procedure has been followed and that the proposals do not undermine the foundation hospital’s primary purpose of health service provision. Should a foundation hospital’s proposals to vary the services listed in its licence give rise to concerns that cannot be resolved, the local authority’s overview and scrutiny committee will be able to refer them to the independent regulator for decision. When this happens the independent regulator will have the power to determine that the proposals should go ahead, to reject them, or to require further consultation. Will foundation hospitals lead to greater inequalities in patient service? Yes. Foundation hospitals will widen the gap between hospitals in the NHS, attracting extra staff and resources at the expense of those that do not have foundation status. And they will be able to use their advantages to compete against other hospitals as part of the new commercial market being created by the Government in the NHS. Foundation hospitals will have several advantages over other hospitals: ● they will be able to hold on to all of the money raised from selling land or other assets. This can be a very large amount – one of the hospitals applying for foundation status, University College Hospital London, is estimated to own £100 million in surplus property. ● they will be allowed to retain any surplus they make. ● they will be able to borrow from private sector lenders as well as the government, giving them access to higher levels of investment. Not only will these advantages place foundation hospitals in a better position than other hospitals, they also run the risk of doing so at the expense of hospitals that do not have
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foundation status. This may happen in the following ways: ● Foundation hospitals may attract scarce staff from neighbouring hospitals. ● because private sector borrowing by foundation hospitals will be counted against government expenditure limits, this may leave less money for non-foundation hospitals – robbing Peter to pay Paul. ● under current rules, money raised by hospitals from the sale of land or other assets goes into a central NHS pot, from where it is redistributed to where the need in the NHS for resources is greatest. This will not happen with foundation hospitals. The Government has said that it hopes that all NHS hospitals will gain foundation status within the next five years, and that there is therefore no need to worry that foundation hospitals will lead to increased inequalities in the NHS. However, this will not do. It is unlikely that all hospitals will be foundation hospitals in five years time. And even if they are, five years is a considerable period of time for inequalities to grow between those hospitals that are at the front of the queue for foundation status and those that are at the back. What will be the governance structure of foundation hospitals? Foundation hospitals will have a new form of governance structure that will differ from other NHS hospitals. This will involve members, a board of governors, and a management board. Foundation hospitals will be owned by their members, who will be drawn from patients, staff and local people. Individuals wanting to become a member of a foundation hospital will be required to register on the hospital’s membership list and to agree to pay up to a pound if the hospital became bankrupt. Staff working at a foundation hospital will be automatically eligible for membership; members of the public will be eligible for membership if they fall within the definition of the foundation hospital’s membership community. Once a year, the members of the foundation hospital will elect representatives to its board of governors. This will have the responsibility for approving the annual report and accounts, for setting the foundation hospital’s strategic direction, and for ensuring that it does not breach the terms of its licence. A majority of the members of the board of governors must be members of the public, and it must also include at least one staff member and one representative each from the hospital’s main commissioning primary care trusts and any universities responsible for undergraduate training at the hospital. The board of governors must elect a chair, who may be drawn from outside its own number. As well as the board of governors, each foundation hospital will have a management board. This will have a duty to consult the board of governors concerning the development of the hospital’s forward plans and regarding any significant changes to the business plan. The management board will be chaired by the chair of the board of governors and at least a third of the places excluding the chair must be filled by nonexecutive directors elected by the board of governors. In addition the management board must include a chief executive, who will be appointed by the chair and nonexecutive directors of the management board, and a finance director. Will foundation hospitals lead to greater local accountability or social ownership? The government has emphasised the idea of community ownership and staff involvement on the boards, in addition to local residents and employers. However,
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UNISON does not believe that foundation hospitals will lead to greater local accountability or social ownership. As public services, the public already owns NHS hospitals. And unlike a mutual, NHS hospitals should be for the benefit of the whole public, not just a small number of ‘members.’ Foundation hospitals are unlikely to provide an effective means of achieving a balanced representation of the full range of groups and interests present within a hospitals’ stakeholder community. Reasons for this include: ● foundation hospitals will be able to run with only a very small number of members in relation to their total user population ● foundation hospitals members will be self-selecting, creating the potential for the under-representation of particular ethnic or social groups and for foundation hospitals to fall hostage to political interests ● It is not clear what safeguards will exist to ensure that boards of governors undertake their duty to consult with foundation hospital members in a genuine or meaningful way ● There was no provision for “privatised” staff to be able to vote in the staff constituency. UNISON raised this with MPs and ministers and as a consequence the proposals have been amended to enable them to vote. What other arrangements are there for involving patients and the public? Although local council overview and scrutiny committees’ powers also now extend to the scrutiny of local health services, foundation hospitals will not have their own patients’ forum but they will be required to “liaise” with local patients forums. UNISON believes that in time as all hospitals move to foundation status this will make a nonsense of the new patient and public involvement arrangements. Why will foundation hospitals be implementing “Agenda for Change” from their establishment? The first wave of foundation hospitals will be established on 1 April 2004 and the new pay system (Agenda for Change) if agreed wiil not commence until October 2004. Therefore, at the date of their creation staff would be on old terms and conditions and, if as under some earlier versions of the foundation hospitals proposals they could set their own pay, staff within them would have been outside the national system. By making foundation hospitals apply Agenda for Change from their establishment it ensures that all staff are on the new system and thus foundation hospitals are tied into it. Ministers have referred to the first wave of foundation hospitals as being “early implementers” of Agenda for Change. This was not the intention and has been raised by UNISON with ministers to be clarified. It is now clear that in order for an applicant trust to get foundation hospital status the regulator has to be satisfied that they are committed to Agenda for Change from their establishment on 1 April 2004. However implementation will be on the basis of a rolling programme from April to October 2004. Will foundation hospitals be able to pay staff more? The guidance on foundation hospitals states that “An NHS foundation hospital will be free to recruit and employ its own staff building on the local flexibilities already available to NHS hospitals. It will have the flexibility to offer new rewards and incentives and explore innovative ways of working in partnership with staff to deliver local services.”
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UNISON is clear following a range of meetings with ministers and civil servants that foundation trusts should not have the freedom to set their own pay rates. However we are continuing to seek greater assurances that they will continue to have to abide by national terms and conditions in the future. Under the new pay system proposals (Agenda for Change) negotiated with NHS trade unions and implemented in all NHS organisations there will be extra local freedoms. Foundation hospitals will be less constrained on the application of recruitment and retention premia and other freedoms than other employers but will still need to consult on their application with the trade unions locally. In addition all NHS employers including foundation hospitals have to be able to give an objective justification for any recruitment and retention premia awarded, including justification of the level of that award. However the freedom for foundation hospitals to be able to set these above the 30% limit set for other hospitals and there being no requirement to consult with other local NHS employers raises considerable concerns over the potential for poaching of staff from other parts of the local health economy. If it is deemed necessary for there to be a coordinated approach for other parts of the health economy then UNISON believes this should be the same for foundation hospitals. Will foundation hospitals be required to comply with national standards? Yes, foundation hospitals will be required to comply with most national standards. It will be a condition of each foundation hospital’s licence that it meets national clinical and quality standards. In addition, foundation hospitals’ service agreements with primary care trusts will specify that the services provided must comply with national quality and safety standards. However, foundation hospitals will not be required to comply with department of health management and operational guidance, and will be exempt from some current management targets. Foundation hospitals will be assessed against national clinical and quality standards by the commission for healthcare audit and inspection (CHAI), the new healthcare inspectorate. CHAI will inspect foundation hospitals, will investigate serious service failures and will award them annual performance ratings. Reports of inspections or investigations that CHAI carries out in foundation hospitals will be passed to the independent regulator. What is the role of the independent regulator? The independent regulator is a new post created by the government to oversee the operation of foundation hospitals. Unlike current NHS hospitals, foundation hospitals will not be subject to the direction of the secretary of state but instead will be licensed, monitored and regulated by the independent regulator. The independent regulator will be appointed by the secretary of state and will have a general duty to act in a way that is consistent with the secretary of state’s duty to provide a comprehensive health service. However, the secretary of state cannot instruct the independent regulator and it will not be possible to appeal to the secretary of state regarding the independent regulator’s decisions. The secretary of state will have the power to dismiss the independent regulator, but only on grounds of incapacity or misbehaviour and not simply because the secretary of state does not agree with the way the independent regulator is carrying out his or her duties. The main functions of the independent regulator will be: ● approving organisations’ applications for foundation status, and issuing them with licences setting out the terms and conditions of their authorisation. This may include
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matters such as the services to be provided by the foundation hospital and the protection of property essential for the provision of these services. ● periodically reviewing licenses, and responding to requests from foundation hospitals for variation of the terms of their licences. ● vetting applications by foundation hospitals to dispose of property which has been given ‘protected status’ under the terms of their authorisation. ● drawing up a prudential borrowing code for foundation hospitals, and yearly reviewing each foundation hospital’s borrowing limit. ● monitoring foundation hospitals’ compliance with their licences, and taking steps to deal with any breaches. The independent regulator will have the power to require foundation hospitals to disclose information and to enter and inspect their premises. In the event of a foundation hospital breaching their licence, the independent regulator may take steps to intervene, for instance by removing some or all of the management board or ordering new elections to the board of governors. The legislation introducing foundation hospitals leaves the independent regulator with significant discretion in a number of areas, including the rules governing foundation hospitals’ private borrowing and decisions regarding the variation of services. Much will therefore depend on the independent regulator’s approach and their interpretation of the ways in which it is appropriate for foundation hospitals to behave. This is worrying, as it will be difficult to hold either the secretary of state or the independent regulator for the independent regulator’s performance. Will foundation hospitals be able to charge patients? In general, foundation hospitals will not be able to charge patients for treatment received under the NHS. Charges for NHS health services will be limited to those authorised by the secretary of state or other authorities under current powers, for example charges for prescriptions and for intermediate care extending beyond a six week period. Foundation hospitals will be able to raise income by charging for the treatment of private patients. However, their private work will be limited by a cap on the proportion of their income that can come from private treatment. The level of the cap will differ for each foundation hospital, and will be equal to the proportion of their income from private income over the year ending 31st March 2003. While foundation hospitals’ abilities to charge for healthcare services will be restricted, they will have considerable abilities to charge for other services not directly related to the provision of healthcare. This could include charging patients for items such as car parking, additional catering and hotel facilities and cable and satellite TV. Many of these practices already take place, but foundation status will encourage their extension by strengthening the commercial incentives on hospitals.
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What is the timetable for the establishment of the first wave of foundation hospitals? The guidance document sets out the timetable for implementation. The key stages are as follows: December
2002
Preliminary applications invited
February
2003
Closing date for preliminary applications
March
2003
Short-listed applicants announced
April
2003
Second stage applications
July
2003
NHS star ratings announced
Autumn
2003
Closing date for second-stage applications
December
2003
Successful applicants announced
December
2003
Establishment phase starts
April
2004
First wave of NHS FHs established
This timetable may change if there are delays in bringing forward the legislation necessary to establish NHS foundation hospitals.
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WHAT IS UNISON SEEKING TO ACHIEVE? UNISON is opposed to the whole concept of foundation hospitals. However we are seeking amendments to the bill as it passes through the various stages in parliament. In particular: 1. That the proposals should be piloted across a local health economy and evaluated before implementation. 2. We are opposed to the proposed independence of the regulator and believe that the secretary of state should retain the ability to intervene in the activities of the regulator beyond the formal ability of the secretary of state to appoint and dismiss the regulator. We believe that the bill should make clear that in exercising his or her functions, the regulator has a legal duty to safeguard the best interests of the NHS as a whole. 3. UNISON is seeking to delete the clause allowing private healthcare corporations to obtain licenses to run foundation hospitals. 4. The government has said that to obtain foundation status, hospitals will be required to demonstrate support from other NHS stakeholders and within the local community. UNISON endorses this principle, but believes that it should be safeguarded through explicit provisions in the bill. We believe that this could be achieved by ensuring that the relevant local authorities, PCTs, patient forums and local staff sides endorse the authorisation. 5. The government has said that private borrowing by foundation hospitals will be counted against the department of health’s overall spending limits. As the chancellor has admitted, this means that increased borrowing by foundation hospitals as a result of their ability to borrow from the private sector will result in a decreased availability of capital finance for non-foundation hospitals, unless overall DoH capital spending limits increase. UNISON believes that it is particularly important to protect against the above eventuality. We believe that the regulator, in authorising a foundation hospital should consider the impact of private borrowing by foundation trusts on other NHS Hospitals access to capital and take into account the views of trade unions, patient bodies and other appropriate organisations. 6. The introduction of democratic accountability into the NHS should be the subject of a wide ranging commission which should examine amongst other things whether it would not be more appropriate to introduce local democracy at primary care trust level.
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BRANCH CAMPAIGNS Introduction Although there is considerable activity at national level on opposing the establishment of foundation hospitals, the key to successful opposition lies at branch level. Although branches in an applicant foundation hospital have a key role to play—all UNISON branches in the area have an important role. This chapter gives advice and guidance to both groups of branches, but firstly gives guidance in the application process. Application process—Department of Health guidance (DoH) Once short listed, in order to proceed to the next stage an applicant trust has to prepare a detailed submission. Exact details of what will be required are being made available to short-listed applicants at the start of the second-stage process but as a minimum applicants will be asked to submit: ● “a report that sets out how the new organisation plans to use the freedoms for the NHS foundation trust status to improve services for NHS patients. This will need to be endorsed by local NHS partners; ● an independent financial review undertaken for the DoH; ● outline plans for their new governance arrangements including proposals for engaging with the local community through membership and the constitution of the board of governors; ● amongst other things, a human resources policy statement agreed in outline with staff which should make clear the terms and conditions of employment for all staff and the transfer arrangements. The report needs to set out the strategic vision for the applicant NHS foundation trust over the next 5 years underpinned by robust and meaningful financial and non-financial assumptions and sound forecasts of expected service demand. The assumptions will need to be backed up by the identification (through sensitivity analysis) of the key financial and non-financial risk areas and the proposed strategy for managing those risks. Applicants need to provide evidence that key NHS stakeholders and others in the local community support both the short and medium term goals. They will also be expected to show how the new organisation plans to apply the principles of local accountability and ownership and the freedoms that NHS foundation trusts status brings to improve services for NHS patients. Second-stage applicants will need to provide evidence that both the NHS trust board and key stakeholders – for example primary care trusts, staff, partner organisations and local people – have been consulted and support the application and the strategic vision. Applicants will be given financial support during the second-stage application phase to free-up resources to undertake the work to develop a business plan for the first 5 years as a NHS Foundation Trust. These resources will also support the applicant trust in consulting local stakeholders on the proposed governance arrangements and constitution of the Board of Governors.”
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(A Guide to NHS Foundation Trusts- DoH www.doh.gov.uk/nhsfoundationtrusts/index.htm).
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Foundation hospital applicant branch Your employer has to show that it has sought and obtained the support of staff for its application. It is important that you do not give this support and campaign against the submission for the reasons given earlier. In doing so you might find the following checklist useful: 1. Contact your regional office 2. Call a branch meeting to discuss with members 3. Familiarise yourself and the branch with the application process 4. Raise issues with the other staff-side unions to build a common front against the proposals 5. Meet with management to discuss their proposals and ensure you are consulted on the proposed human resources framework 6. Keep regional office up to date with the progress of the application 7. Set up a branch campaign team 8. Involve the local community, and other local UNISON branches in your campaign Contact your regional officer It is important that you involve your regional office at an early stage in the campaign. They can give you advice and assistance. Call a branch meeting to discuss with members To win the campaign you will need the support of members. Materials and speech notes to assist in this will be issued shortly. Familiarise yourself and the branch with the application process Information on the timetable and the application process is set out on pages 13 and 15. It is important to note that the trust is supposed to have evidence of the support of staff before proceeding with the application. Raise issue with the other staff-side unions to build a common front against the proposals It is vital that there is a united front against the application at a local level. Most NHS unions support the campaign and none are in favour of foundation hospitals. UNISON is building a coalition of trade unions and special interest groups in opposition to the proposals. This list will grow and it is early days. The list will be sent to branches in a briefing. Meet with management to discuss their proposals and ensure you are consulted on the proposed human resources framework Foundation hospital status will change the employment position of staff. The bill provides for a TUPE type transfer. Assurances have been given on pensions, redundancy etc but it is important to follow this up at a local level. Further advice will be issued on this and on the implementation of Agenda for Change. Keep regional office up to date with progress of application For the campaign to succeed it is important that there is a co-ordinated approach across all branches in foundation hospitals. It is also important that information is exchanged with other unions, UNISON branches, regional office and head office. Set up a Branch campaign team UNISON is adopting a twin track approach to the establishment of foundation hospitals. The aim is to stop their establishment by applying pressure to politicians and opinion
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formers and achieving amendments to the bill. It is important that MPs and ministers know the strength of local opinion. This in turn assists in the lobbying of MPs and government at a national level. This local support will also be necessary if the legislation is passed and your local trust becomes a foundation hospital. There will be much work to do in a campaign against foundation hospitals. Start by forming a campaign team to share out the work. One job is to try and identify arguments you can use most effectively with the target groups in your campaign. You can do this by thinking about what arguments your employer may put forward and how you will counter them. Regular briefings will be issued from national office. Involve the local community, and other local UNISON branches in your campaign It is claimed that foundation hospitals are a form of “social ownership” or “community ownership”. The campaign against foundation status will not be easy. Some parts of the community and staff may welcome foundation status believing that there will be a greater say in the running of the hospital and that it has a greater status than other local hospitals. Local councillors and MPs will often be ignorant of the true facts, or the long-term implications. You may have to argue with other unions and the local media may lose interest unless there is something new to report. Briefings speech notes and draft press releases will be sent to you to assist with this. The case against foundation hospitals, however, is a strong one. The government was forced to make changes even before the publication of the bill and has since made others. The pay freedoms are much watered down from the original proposals. At local level even if the foundation hospital is eventually established the campaign will have strengthened our ability to negotiate better protection for our members. All UNISON branches The introduction of foundation hospitals is a threat to the whole ethos of a publicly provided NHS. It is a threat to all of us as citizens. It is important that full opposition be given to the establishment of foundation hospitals at a local level. There is much you can do to both on your own and together with those health branches in applicant NHS Trusts. 1. Special item/presentation at regional council meeting. 2. Invite speakers from the affected branch to address your branch members. 3. Set up liaison arrangements with the branch, other trade unions, the local Labour party and interest groups. 4. Join in or instigate local campaigns including organising public meetings with the assistance of your region. 5. Lobby local MPs. 6. Enlist support of the local primary care trust(PCT). 7. Encourage the local council’s oversight and scrutiny committee to scrutinise the proposals (advice on this is at Appendix A).
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8. Encourage your members as part of the local community to express their views to local opinion formers. 9. Use the local media, local television, newspapers, radio. Briefings and other materials to assist in local campaigns will be sent to branches as the campaign develops.
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What local groups/unions should branches link in with for the campaign? ● Local government scrutiny committees ● Non executives on PCTs ● Community health councils and patient forums ● Trades councils ● Trade union branches ● Local Labour party ● Community organisations (Help the Aged, CVS) ● NHS Support Federation ● GPs
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APPENDIX A Overview and scrutiny committees A full briefing on the health scrutiny role of local councils’ overview and scrutiny committees and how this relates to the new patient and public involvement structures will be issued in collaboration with our coalition colleagues at the democratic health network. However here is some initial advice on the role and remit of these committees in relation to local health services. 1. The Health and Social Care Act 2001 conferred on local authorities with social services responsibilities the role of reviewing and scrutinising health service matters and making reports and recommendations to NHS bodies; 2. It placed duties on health trusts to consult health scrutiny committees on substantial developments and variations to services; 3. It requires officers of health trusts to attend scrutiny committees when requested; 4. It requires NHS bodies to provide health scrutiny committees with information about the planning, provision and operation of health services; 5. Requires NHS bodies to respond (normally within 8 weeks) to reports and recommendations of health scrutiny committees but does not require them to implement such recommendations. A number of overview and scrutiny committees have already announced their intention to “call in” the proposal for the establishment of a local foundation hospital.
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KEEP THE
PUBLIC Foundation Hospitals
a UNISON branch guide August 2003
Designed by UNISON’s Communications Unit. Published and printed by UNISON, 1 Mabledon Place, London WC1H 9AJ. CU/August 2003/job number 13655/stock number 2248/UNP ref number 6946.