Foundation Hospitals – 10 years on

Foundation hospitals were a radical step when introduced - but 10 years on, more work needs to be done to make them truly owned by their members.

Karin Christiansen


Many of us remember the creation of Foundation Trust hospitals back in 2003 for the political tussle that they created. At the time, the reforms crystallised long-running debates within the Party and wider labour movement about public service reform, the meaning of public ownership, and the future of the NHS.

We as the Co-operative Party believe that it is time for a debate about what has been achieved in ten years of member ownership of Foundation Trust hospitals, and the lessons it holds both for the NHS and the delivery of our public services more widely.

The organisation Monitor – the regulator of NHS trusts in England – reports that Foundation Trusts have over 2 million members and that in around 50% of these trusts, members are influencing decisions. The model has for the first time sought to resolve the genuinely difficult conundrum of how you meet the public desire for both a national health service and one that is more locally accountable.

However, recent research from Co-operatives UK presented at a Co-operative Party event held in Westminster this week highlights that too often, members have relatively little power or voice within the running of Foundation Trusts, other than the right to vote for Trust Governors.

This lack of member control will be exacerbated by the 2012 Health and Social Care Act which has centralised powers previously held by members into the hands of Trust Governors. It also risks undermining the principle of membership, and diluting members’ influence by opening up Trust AGMs to the public at large.

As a Party, we passionately believe that democratic accountability can play a crucial role in driving innovation, responsiveness and effectiveness in public service delivery. We also believe that the idea behind Foundation Trusts can help us to meet some of the biggest challenges facing the NHS; namely improving transparency and patient safety (urgent issues in the light of the shocking findings of the Francis review), and the need to make patients more active participants in their own healthcare.

This is particularly important for those with long-term and chronic conditions. It is heartening, for example that some of the best practise in Foundation Trust membership engagement is to be found in mental health trusts which are engaging service users in shaping services. Patients, staff and management in such trusts are working together to raise mental health provision out of its ‘Cinderella status’.

But it is clear that there is a long way to go before we realise the dream of a more people-powered NHS.

In the past, we too often confused public ownership with state control. Increasingly we need to consider new forms of ownership and accountability that put the people using and working in those services, rather than the man in Whitehall in charge. This is particularly important in the NHS, one of our most precious public service institutions. The scale of the challenge is great but the potential rewards make it worth the effort.