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NHS: Foundation Trusts

Volume 747: debated on Tuesday 16 July 2013


Asked by

To ask Her Majesty’s Government what progress the NHS Trust Development Authority will have made by April 2014 with NHS Trusts becoming NHS Foundation Trusts; and when they forecast that the Authority will have completed its work.

My Lords, in the light of Robert Francis’s recent report, we have allowed the NHS Trust Development Authority to agree trajectories for NHS trusts to reach foundation trust status that go beyond 2014 on a case-by-case basis. In doing so, we will ensure that the primary focus of the NHS Trust Development Authority and of NHS trusts themselves is on improving the quality and sustainability of services for patients.

My Lords, I thank the Minister for that reply. Does he recall that in a recent Written Answer to me he identified 26 acute hospitals under the stewardship of the TDA which have cumulative deficits running into hundreds of millions of pounds? Does he agree that many of them are unsustainable and potentially unsafe and need their services reconfigured? Will he tell the House why the Government refuse to publish the review by Sir Ian Carruthers on the procedures for service reconfiguration and why they resist publication by declining FOI requests?

My Lords, there is no doubt—and we have never denied this—that there will be a hard core of organisations which will be very difficult, if not impossible, to bring to foundation trust status. For those trusts, it is necessary to look at other options, including, for example, mergers. That work is being taken forward. Although some trusts are in deficit, the NHS TDA is working very hard to mitigate those deficits in-year and when the first quarter board papers are published in September we will know what its predictions are for all trusts for the current year. I will come back to the noble Lord on the report of Sir Ian Carruthers because all FOI decisions are reviewed at regular intervals to make sure they are current. I want to make sure that there is a plan to release that information in due course. I am sure that there is.

My Lords, following yesterday’s Written Statement, in which the Government indicated total support for the review carried out so expertly by the noble Baroness, Lady Neuberger, on the Liverpool Care Pathway, can my noble friend the Minister confirm that the trusts will take immediate action to implement its recommendations?

My Lords, I hope my noble friend will allow that that is a little wide of the Question on the Order Paper, which is about bringing trusts to foundation trust status. Nevertheless, I refer my noble friend to the Written Answer which was published in Hansard yesterday and which sets out the immediate steps we have taken to instruct all hospitals to review all patients currently on the Liverpool Care Pathway and to make sure that there is a named, responsible clinician for every patient at the end of life.

My Lords, I refer noble Lords to my health interests in the register. Is the failure to publish the reconfiguration paper by Sir Ian Carruthers due to the intervention of the Competition Commission in proposed mergers and reconfiguration of services in the NHS? Is the noble Earl aware that it was reported in the other place this morning that the intervention of the Competition Commission in the Dorset merger will cost £6 million which should have been spent on patient services? When will the Government start to ensure that the foolish intervention by the Competition Commission which is not needed in the health service stops and money that could be spent on patient services is actually spent on them?

My Lords, I am sure the noble Lord is aware that the provision for reviewing NHS mergers on competition grounds is not at all new. Responsibility for reviewing NHS mergers has moved from one independent body—the Co-operation and Competition Panel—to another, the OFT. This is a continuation of the approach that has been in place since 2009. In all these decisions what matters is what is in the interests of patients. The competition authorities will continue to review whether the potential benefits of a merger outweigh the potential costs to patients.

My Lords, would my noble friend confirm whether any of those trusts yet to achieve foundation trust status were planning to merge with any on today’s Bruce Keogh list?

I am not aware of any on Sir Bruce Keogh’s list which were planning to merge but, if I may, I will write to my noble friend with further details if that needs clarifying.

My Lords, my interests are declared in the Register of Lords’ Interests. Complicated organisations, such as hospitals of every sort, need outstanding, in-depth leadership from all quarters. Does my noble friend agree that clinicians should provide that leadership but that if there is an overwhelming culture of retribution there is no incentive for them to take on these very demanding roles? What incentives can the Government introduce to ensure that the most talented doctors and nurses are attracted to lead the NHS and take on these very high risk jobs?

My noble friend makes a vital point. If we are to strive for excellence in the health service, leadership is essential. That is the reason why the NHS Leadership Academy has been established—to encourage not only managers but clinicians and nurses to take leadership roles in the health service for the very reasons that my noble friend states.

My Lords, given the Government’s commitment to the duty of candour in the NHS, can the Minister give us an indication of some of the reasons why there has been a long delay in the production of Sir Ian Carruthers’s report?

My Lords, I am not aware of the underlying reasons why Sir Ian Carruthers’s report has not been released. As far as I am aware, that is a matter for NHS England. However, if I can enlighten the noble Lord, I will be happy to write to him. I can say that the programme for bringing trusts to foundation trust status has to be taken slightly more slowly than we thought was appropriate perhaps a couple of years ago. That is because of the Francis report. I make no apology for that, because it is right for trusts to take a longer and harder look at the issues that Robert Francis flagged up.