• What is a Foundation Trust?
• Why do we need NHS Foundation Trusts?
• What difference will this make to you?
• Will NHS Foundation Trusts lead to privatisation of the NHS?
• How will Foundation Trust status affect the Royal National Orthopaedic Hospital’s finances?
• How are Foundation Trusts regulated?
• Will NHS Foundation Trusts be able to opt out of the NHS?

What is a Foundation Trust?

A NHS Foundation Trust is an Independent Public Benefit Corporation that involves service users, carers, the public and staff in the way it is run. They are fully part of the NHS and provide free care based on the needs of patients. They have greater freedom to run their own affairs. They are required to:

• Maintain high national standards for NHS services
• Deliver NHS services to NHS patients free at the point of use
• Treat patients according to need, not ability to pay
• Work in collaboration with other health and social care partners

The Department of Health proposed that NHS Foundation Trusts be established because they recognised that improvements in NHS performance could only happen when local staff and communities had a greater say over how their services were run. These organisations are established in law as ‘public benefit corporations’ similar to mutual organisations. They are still required to carry out their primary purpose of providing NHS services for NHS patients and are not able to use their property or resources for any other purposes.

NHS Foundation Trusts differ from NHS Trusts in four key ways. They are:

1. directly accountable to local people through an elected Board of Governors
2. approved by an Independent Regulator, known as Monitor, which issues an authorisation under which they operate
3. accountable to NHS commissioners, Primary Care Trusts, through legally binding contracts
4. allowed new freedoms to reflect local needs and priorities, particularly in how they spend their money

Public, patients and staff can become members and governors of the Foundation Trust. In this way, Foundation Trusts become focused on meeting the requirements of the communities they serve. They work in partnership with other NHS organisations. They also have a duty to co-operate with other local partners in the best interests of their health communities. They are accountable to Parliament and inspected by the Healthcare Commission.

Why do we need NHS Foundation Trusts?

The Government wants the NHS to be a service that is properly responsive to patients' needs and provides fast, convenient, high quality care. More money is being invested in the NHS than ever before. Alongside this extra money, the NHS must reform to become a service shaped around the needs of patients and the skills of clinical staff.

If Foundation Trusts are to succeed, they need to be led by local communities and by NHS professionals delivering services locally. So, having put a system of national standards and inspection in place, the Government now wants to liberate the talents of staff and local communities.

What difference will this make to you?

For the first time, the public, patients and staff have a way to really influence how the Trust is run. Decisions are taken locally which means that the Trust is more responsive to the needs of patients. This will also allow the Trust to concentrate more on the needs of its communities when looking at how national targets will be achieved.

For the first time, patients will have a way to direct and shape the Royal National Orthopaedic Hospital. For example, if an MRI scanner will improve our service to patients, then as a Foundation Trust we can use existing funds or borrow money to purchase one without the need to refer to a central hierarchy for approval.

The public will have true social ownership of their hospital, with accountability devolved from Whitehall to the Trust’s communities.

Public, patients, staff, partners and other stakeholders will have the opportunity to become involved in the running of the RNOH, with rights to elect governors or become members.

Will NHS Foundation Trusts lead to privatisation of the NHS?

No. Foundation status does not mean privatisation – Foundation Trusts are still fully part of the NHS and continue to provide care free at the point of delivery. They are about devolving power from the centre in a new form of social ownership. Foundation Hospitals are similar to mutual organisations such as co-operative societies and housing associations. Foundation Trusts are also legally prevented from having shareholders and their members can make no profit from them.

How will Foundation Trust status affect the Royal National Orthopaedic Hospital’s finances?

As a Foundation Trust, the Royal National Orthopaedic Hospital will be able to retain its financial surpluses, borrow capital and use its assets to improve and develop services for its users.

How are Foundation Trusts regulated?

The independent regulator Monitor oversees the operation of Foundation Trusts. Unlike current NHS hospitals, foundation hospitals are not subject to the direction of the Secretary of State but instead are licensed, monitored and regulated by Monitor.

Will NHS Foundation Trusts be able to opt out of the NHS?

No, becoming an NHS Foundation Trust does not mean opting out of the NHS. NHS Foundation Trusts are fully part of the NHS and subject to NHS systems of inspection. They treat NHS patients according to NHS principles and NHS standards, and will continue to co-operate with the rest of the NHS.