1 Foundation Trusts (FT’s) – Background.
A detailed guide to NHS Foundation Trusts and UNISON’s position on the issue can be found on our website at http://www.unison.org.uk/foundation/index.asp . Some knowledge of the steps that need to be taken by trusts to achieve foundation status is essential for UNISON representatives to maximise their influence and involvement.
2 The FT process and timescales.
In brief, trusts have to satisfy their Strategic Health Authority (SHA), The Department of Health (DH) and ultimately Monitor, the FT regulator that they are suitable to become a foundation trust. Along the way a number of standards have to be met relating to quality, finances, governance and business planning.
The first stage entails a diagnostic assessment of the Trust by their Strategic Health Authority (SHA) on the likelihood of their application for FT status being successful. This has the effect of producing an action plan that identifies areas that need improvement and an estimated timescale for readiness for an application to progress to the next stage (scrutiny by the DH). This is not likely to be much less than a year in the “best case” scenario.
The DH scrutiny stage is referred to as phase 1 in the Monitor / DH guidance for FT applicants (available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073630 ). This envisages a further period of 43 weeks elapsing between phase 1 and the Monitor board final decision on the FT application (end of phase 4). In effect the process will take the best part of two years to complete providing all the requirements have been met.
Stage / Phase Time Scale (weeks) Aggregated (weeks)
SHA diagnostic 52 52
Phase 1 – DH Entry 4 56
Phase 2 – DH pre-submission 18 74
Phase 3 – Historical Due Diligenc 7 81
Phase 4 – Monitor Assessment 14 95
3 Maximising UNISON’s influence and involvement.
UNISON opposition to FT’s is well known and well documented (see website link above). However we recognise that branches have to work with FT’s in order to protect the interests of our members. How deeply branches get involved in the governance structures has to be a local decision based on relations with local management sides, and, of course most importantly the views of the members.
In any event UNISON representatives should be as fully informed as possible throughout all stages of the process. Initial requests for information should be formally pursued through the existing local joint industrial relations mechanisms.
Whilst the main determining factor in achieving FT status is current financial stability and future viability a successful FT business plan must also incorporate an acceptable Human Resource strategy and demonstrate meaningful stakeholder involvement. Key references in the DH guide are as follows:
Page No 14, Section 3.4 Phase Two – DH Pre-submission Phase
Bullet point 3 – demonstrate that they have the support and involvement of staff and other local stakeholders for their vision for reform;
Page No 17, Section 4.2 Phase Two – DH Pre-submission Phase
Bullet point 5 – finalise it’s detailed five year integrated strategic business plan, which will incorporate the HR implications, i.e. workforce requirements and plans to effectively involve, engage and develop the workforce, along with wider plans for organisational development whilst continuing to maintain compliance with statutory obligations:
Page No 19 / 20, Section 4.2.2 Phase Two – DH Pre-submission Phase
See whole section but especially final paragraph as follows:
Organisations need to give all their staff opportunity to contribute to the development of proposals as well as engage in discussion with other local NHS organisations and other key stakeholders, for example unions, and relevant education and training establishments and other local HR teams and departments within the health community. Evidence and action taken as a result of the feedback received must be included in the application documentation when submitted.
To quote the introduction to 4.2.2 on page 19 “NHS Foundation Trusts are expected to be model employers” A major impediment to Ambulance trusts meeting this criteria might be a failure to address the issue of having a number of different HR policies and staff related procedures still in place based on those in existence prior to merger. Issues such as this are only likely to be resolved amicably in partnership with the staff trades unions.
4 Ambulance Foundation Trusts
It is a stated aim of all English Ambulance Services to achieve FT status. The employers are co-ordinating their efforts through the Ambulance Service Network (ASN) that is part of the NHS Confederation, the independent membership body that represents over 95% of NHS organisations.
The NHS Confederation also has a Foundation Trust network. This will also be providing assistance to Ambulance Trusts in achieving FT status. There are currently two trusts, North East and London that are working on producing a “diagnostic tool” to assist in the initial SHA assessment that can be used by other Ambulance trusts. On the basis that these are the two most advanced trusts in the process it is unlikely the first Ambulance Foundation trust will be with us until beyond April 2009.
As stated above local trade union representatives should be involved at the outset of the process. In North East Ambulance Joel Byers, the UNISON representative attends FT board meetings as an observer.