Becoming a Foundation Trust A brief guide for Clinical Commissioning Groups

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Transcript of Becoming a Foundation Trust A brief guide for Clinical Commissioning Groups

  • Slide 1
  • Becoming a Foundation Trust A brief guide for Clinical Commissioning Groups
  • Slide 2
  • Contents Introduction - Role of Clinical Commissioning Groups in Provider Development - Overview of provider side reform - Overview of Health and Social Care Bill - The landscape for providers will change significantly - As a result there will be reforms to the provider landscape and a new role for Monitor - New provider landscape - The Governments reforms have substantial impact on the provider landscape - Deadline for FT status - Criteria NHS Trusts must meet - Traditional route to becoming a Foundation Trust - Key principles for Foundation Trust authorisation - Tripartite Formal Agreements -
  • Slide 3
  • Contents (Continued) NHS Foundation Trusts - The benefits to commissioners of Trusts gaining Foundation Trust status The Role of Monitor - Potential obstacles to becoming a Foundation Trust - Economic regulation - Introducing economic regulation to the NHS - Further Information -
  • Slide 4
  • Introduction All NHS Trusts should become Foundation Trusts on their own, as part of an existing FT or in another organisational form by April 2014. It is government policy that NHS hospitals should run their own affairs and be accountable to local people and patients, as opposed to being subject to top-down direction from the Department of Health (DH). To obtain FT status requires strengthened board governance, financial disciplines that promote long-term financial viability, and a framework to secure delivery of quality services. Monitor is the independent regulator of NHS FTs and is responsible for assessing applicants for FT status and subsequently regulating them once they are approved. Monitor sets out the criteria aspirant Trusts must meet. This brief document outlined the key stages to becoming a Foundation Trust and the points at which commissioners will become involved in that process.
  • Slide 5
  • Role of Clinical Commissioning Groups in Provider Development Maintain an ongoing dialogue with aspirant FTs, supporting commitments set out in the tripartite formal agreements (TFAs) Ensure support and sign-up to the activity levels agreed by both parties in the NHS Trust plans Ensure NHS Trusts engage with and endorse provider strategies that support sustainable local healthcare, reflecting patient needs Take actions to ensure appropriate providers and models of care are available to meet commissioning requirements Support the development of Trust FT applications specifically with activity plans and overall health system strategies Support Trusts in developing sustainable business models to achieve FT status Provide support to NHS Trusts to ensure they are aware of the Equality Delivery System NHS Trust NHS Foundation Trust CCGs must:
  • Slide 6
  • 1. Overview of provider side reform
  • Slide 7
  • Overview of the Health and Social Care Bill The Health and Social Care Bill and the Governments response to the White Paper consultation include plans that will affect every part of the NHS Commissioners: radical reforms to devolve commissioning responsibilities to GP commissioning groups Regulators: Monitor to become economic regulator from 2012 and will run a joint provider licensing programme with CQC Providers: Implementing any willing provider alongside mandating all NHS acute and mental health trusts to become FTs Key themes Moving away from excessive bureaucracy and top-down control towards more decision making by patients and health professionals Using market mechanisms (including competition and failure) to drive improvements in value and quality
  • Slide 8
  • The landscape for providers will change significantly Goal Improved value & patient outcomes Levers Any willing provider Provider freedoms Fair competition Wholly FT landscape Enablers Rewarding success Allowing failure & exit Consequence Providers exiting the market Innovative providers entering the market and expanding
  • Slide 9
  • As a result there will be reforms to the provider landscape and a new role for Monitor New provider landscape Market entry All NHS providers to become FT on their own, part of an existing FT or in another organisational form Reforms to the FT model Any qualified provider Licensing providers of NHS care Protecting and promoting patients interests Role for Monitor Setting prices for NHS care Supporting service continuity Preventing anti-competitive behaviour
  • Slide 10
  • 2. New provider landscape
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  • The Governments reforms have substantial impact on the provider landscape The Health and Social Care Bill proposes several key reforms to the provider side of the NHS, all of which will have potentially significant consequences In broad terms, the Bill and the consultation response split providers into three different groups, NHS Trusts that have yet to become Foundation Trusts; Current Foundation Trusts; and Independent Sector providers The reforms have differential impacts on each of the groups As a result of the changes to the provider landscape there will be changes to the role of Monitor in its role as regulator of Foundation Trusts
  • Slide 12
  • Deadline for FT status There is a strong expectation that all public sector health providers will be Foundation Trusts by April 2014 if possible. However a number of Trusts have said themselves they are not clinically of financially viable for the longer term and might not meet this deadline As a result of this and the abolition of Strategic Health Authorities, all NHS Trusts that have not gained FT status by April 2013 will be put under the guidance of a newly-constituted Special Health Authority, the NHS Trust Development Authority (NTDA) The NTDA will support Trusts to FT status, OR work on an agreed solution to their future form, for example merge with an existing FT. Clear signals are being sent to providers indicating that they are co-responsible for achieving this. A new single operating model for the four SHA clusters management of the FT Pipeline will be operational by January 2012, foreshadowing the single national approach. Monitor will continue to assess whether organisations meet the necessary financial and governance requirements (the FT Bar). There will be no lowering of the assessment bar in order to ensure that organisations will be fit for purpose.
  • Slide 13
  • Criteria NHS Trusts must meet Monitor is responsible for assessing and authorising applicants for NHS Foundation Trust status and for their regulation afterwards. Before submitting an application to Monitor, trusts have to gain the approval of their Strategic Health Authority (upon abolition of the SHAs the NHS Trust Development Authority will take on this role ) and the Secretary of State. Part of this key initial approval is the support of their local commissioners formerly the PCT, but increasingly of their CCG(s). Once these support areas are secured, the application goes forward to the Department of Healths Applications Committee which reviews it and advises the Secretary of State on its merits. If approval is secured, the Trust then submits its application to Monitor. Secretary of State Support Phase 1.Applications committee review application and make the recommendation to the Secretary of State 2.Secretary of State support granted 3.Trust is invited to formally apply to Monitor Monitor Phase 1.Application review by the Assessment Team Is the applicant legally constituted? Is the applicant financially viable? Is the applicant well governed? 2. Interviews with the Care Quality Commission, SHA, and PCTs/CCGs 3. Board to Board meetings SHA led Development Phase 1.Pre-consultation 2.Public consultation 3.Post consultation 4.Historic due diligence report 5.SHA and trust submit application to the Department Authorisation granted DeferralRejection Commissioner support vital in planning, monitoring, and FT application SHA led Development Phase SHA works with Trusts to develop robust and credible NHS Foundation Trust applications. Activities include: 1. Pre-consultation: Trust review Board review Draft business plan and financial model Bespoke support SHA decides that the applicant is now ready to proceed to: 2. Public consultation minimum 12 weeks 3. Post consultation: Finalisation of consultation Final business plan and financial model Historical due diligence sourced and actioned Board-to-board practice All actions from 1) above, delivered 4. SHA confirms the Trust is ready to move into second phase Secretary of State Support Phase 1.When SHA is satisfied that Trust is ready, Trust formally applies to Secretary of State, with SHA full support 2.Applications Committee considers applications and provides advice to Secretary of State which Trusts be supported to proceed to Monitor for assessment and, if successful, authorisation 3.Final decision by Secretary of State Monitor Phase 1.Department of Health advises Monitor of supported applicants 2.Trusts formally apply to Monitor 3.Monitor will carry out its full assessment process Is the applicant legally constituted? Is the applicant financially viable? Is the applicant well governed? 4.Interviews with the Care Quality Commission, SHA, and PCTs/CCGs 5.Board to Board meetings See next page
  • Slide 14
  • Traditional route to becoming a Foundation Trust Intervention Points for CCGs Secretary of State Support Phase When SHA is satisfied that Trust is ready, Trust formally applies to Secretary of State, with SHA full support Commissioners provide a letter of support Applications Committee considers applications and provides advice to Secr