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NHS Foundation Trusts and Changing the Market Structure : Some Messages

Malcolm Lowe-LauriCEO, King’s College Hospital NHS Foundation Trust

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• Break through change through supply side deconstruction

• New market entrants

–Primary care providers

– Independent Sector Treatment Centres

• Tentative deregulation of NHS hospitals

–Account to regulator

–Compensated for work done

–Keep profits

–Borrowing powers

–Account to communities, with limitations

• To sit alongside other policy changes, especially Patient Choice and Payment by Results

The Policy Origins of NHS Foundation Trusts

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How have Foundation Trusts performed?

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How have Foundation Trusts performed?

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• Significant variations though recent marked improvement

• Clusters of deficit e.g. Outer S.E. London

• Some correlation with clinical quality and safety issues

• Aggravated by asset renewal through the Private Finance Initative

• With more pressure – legal, financial – to come

How have NHS Trusts performed?

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• Acquisition of Good Hope Hospital by Heart of England F.T.

• Pre-acquisition discussion in Cambridgeshire, but FTs are cautious

• ‘Darzi’ plan for London challenging the District General Hospital concept

• Darzi now going national with Next Stage Review

Responses: consolidations and planning solutions

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• This is historically a supply-led environment

• The commissioning unit – the Primary Care Trust – has been undersized and underpowered until recently with a dramatic ambition to world class

• It must battle pork barrel politics and strong local sentiment

• So, FTs may have an emerging leadership role

The challenge for Commissioners

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• Applies to FTs and non-FTs

• The current university hospital lacks scale

• The pricing system for NHS services lags behind innovation

• We need to compete globally

• Academic funding streams are currently unstable

The Academic Health Sciences Centre Question

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• Consolidations to create AHSCs

• Novel partnerships to support own service delivery

• Novel partnerships to support struggling hospitals – new role for the private sector?

• Power in the investment potential of FTs to support policy

• But of course when it comes to professional perspectives, politics and transition costs it’s not as simple as that!

So whither an Academic FT?