A survey of Foundation Trust heads has provided evidence, for the first time, that FT governance arrangements are working well, and that trusts are at the forefront of ensuring local accountability in health services, says the Foundation Trust network.

FTs, the first of which came into being in 2004, are a flagship component of the government’s healthcare reform programme, and play a key role in the drive to move away from a centrally-reigned Service to one that is managed locally, giving local communities responsibility for delivering acute healthcare services.

This allows each trust more autonomy in managing its own affairs, with more financial and operational freedom, while being assessed by an independent regulator. Each trust has a duty to consult a board of governors - consisting of patients, staff, members of the public and other key stakeholders - in the strategic planning of operations, thereby allowing the best decisions to be made in the interests of the local population.

Now, according to the Network, almost 90% of governing boards play a key role in steering the strategic direction of their trusts and making sure that the focus stays with meeting patient needs. Furthermore, the survey has revealed that 85% of boards are influencing trusts’ priorities and policies, with nearly two thirds challenging the policy decisions of FT corporate boards.

“These results give us real proof that FT governance arrangements are working,” said Sue Slipman, Director of the FTN. “We are now witnessing unprecedented levels of public and civic engagement in health.”

“FTs are on a journey,” she said, “and…to make sure that they thrive, FT chairs need to ensure that they invest time, energy and resources into their boards of governors and governors themselves must grow their roles, so that they can play an even more effective, strategic role on behalf of patients and the public. Critical to this is the development of mutual trust and confidence between governors and the board of directors.”

Performing well

It seems that FTs are living up to expectations, both in service provision and financial performance. According to a report by FT watchdog Monitor, trusts are now on the way to generating a surplus of nearly £200 million for 2007/8, and total membership is expected to hit 1.5 million by the end of the financial year, further strengthening local accountability.

Capital expenditure of £921 million is being sunk into projects that will directly benefit patients and staff, the regulator says, but adds that it is encouraging FTs to consider other investment opportunities, such as developing innovative service delivery and investing in high-calibre staff, to drive further improvements in patient care and implement longer term strategic plans.

In terms of service provision, a Monitor report in July claimed there is growing evidence to show that FTs are offering better-quality, more-responsive services than non-foundation trusts.

“Although NHS foundation trusts were a controversial aspect of the Government reform agenda for health, we believe the concept is increasingly accepted as the benefits to patients become more and more apparent,” Executive Chairman Dr William Moyes said at the time.

The current target is to enable all NHS hospitals to apply for FT status by 2008.