Sunday, December 17, 2006

Community Foundation Trusts - NHS changes not in the news (yet)

Just over a week ago on 11 December, the Department of Health published "The NHS in England: the operating framework for 2007/08". It touched on changes in the way that Primary Care Trusts work. Surprisingly after past furore over so-called "privatisation" of primary care, there was no kerfuffle over the document. (Stick "Community Foundation Trusts" into Google News if you don't believe me.) Presumably there will be such cries when PCTs move down this path.

The operating framework talked about extending the Foundation Trust model to primary care. (The FT model was developed in the first instance for hospitals.). The framework elaborated on previous plans for Primary Care Trusts to hive off their direct provision to Community Foundation Trusts. The operating framework said:

community NHS FTs: we have been working with Monitor and a group of interested PCTs to explore the feasibility of NHS FT status as one of the options for providers of community services.We are looking at how this might work in a small number of areas. Like other NHS FTs, Community NHS FTs would be publicly-owned organisations that would be part of the NHS. They would have greater operational freedoms to respond to the needs of commissioners and patients. Further discussions will be carried out with stakeholders around these options, and we will involve staff and their unions, as well as patients and the public, in considering how this work might be taken forward

The Keep Our NHS Public website was strangely quiet on the extension of Foundation Trusts to primary care. However, it is likely that they will condemn this as "privatisation". In the past Frank Dobson referred to the idea of Community Foundation Trusts as "crackers".

The Kings Fund think tank views these proposed organisations positively: “We welcome the idea of community foundation trusts alongside other providers, such as social enterprise organisations, as they provide a solid model for engaging patients and the public. These are likely to be small-scale organisations however and so shouldn’t be overly burdened by bureaucracy.”

The Department of Health appears to continue to support the involvement of social enterprises in primary care saying that they "bring new opportunities for PCTs to enhance the quality of health and social care provision and to better fit services to the needs of particular client groups."

Community Foundation Trusts would be an option, often along side social enterprises. There may be a scale threshold on Community Foundation Trusts so there number may be restricted.

If Community Foundation Trusts operate with the accountability and membership arrangements of mutual societies, they should be welcomed - even if there are only a dozen or so such organisations. Hopefully, they will more actively promote these arrangements of governance by the members of the Trust than the Foundation Hospitals. (Indeed, these governance arrangements will be particularly important for Community Foundation Trusts where they account for a substantial proportion of local primary care provision.)

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