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Exclusive: Nearly 50 trusts 'have no independent future'

Nearly 50 NHS trusts are likely to face merger or franchised management as they are unable to gain foundation status in their current form, HSJ has learned.

Of the 99 NHS hospital, mental health, community and ambulance providers which have yet to become foundation trusts, nearly half will be unable to do so as independent organisations, according to the authority responsible.

The FT pipeline is the subject of the latest HSJ Briefing, published today, and of HSJ’s FT Pipeline Tracker Map.

The NHS Trust Development Authority, which is responsible for managing trusts and preparing them to become foundations, has confirmed to HSJ that only 52 would have a “standalone solution”.

That leaves 47 which do not.

The total is significantly higher than previous estimates of how many trusts would not become foundation trusts, which put the number at around 20.

There are 19 trusts across England where a merger has either been agreed or proposed with another trust, or where use of the failure regime has been discussed. This suggests a further 28 trusts which have not yet been identified will not be able to continue in their current form.

Sixteen trusts have already been referred to Monitor for consideration. Some, such as Kingston and West Sussex Hospitals, are expected to be authorised shortly, although others may have their applications deferred for up to a year.

The remainder have either submitted an application to the NTDA for a decision on their future; are due to submit it soon; or have doubts over their future independence.

However, one senior source said the political appetite for using the failure regime legislation had dwindled in recent months.

Read the full briefing on the FT pipeline here.

The revelation that 47 trusts are very unlikely to have an independent future appears to indicate many of the 18 aspirant community foundation trusts will not be authorised.

They are widely considered to be vulnerable to competition, and among the most likely to be taken over.

Cambridgeshire Community Trust is in the process of being split up after commissioners said they would not support it as an independent FT.

Sussex Community Healthcare Trust told HSJ it was awaiting the result of discussions with the NTDA about whether it had a standalone future. Its services may be taken on by Sussex Partnership Foundation Trust or Western Sussex Hospitals Trust.

However, there is a possibility that a change in rules under consideration by Monitor could improve community trusts’ prospects. The regulator is considering a change in the way it assesses organisations’ financial risk, which would remove consideration of the value of their assets – something which has so far disadvantaged community trusts.

Readers' comments (18)

  • There is actually 102 non-FTs - not 99.

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  • I have been watching out for Leeds. Anyone aware of what is likely to happen ?

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  • Hi anon 12:56, I have checked it a couple of times and think I have the number right. But if you look at the spreadsheet attached to the longer version here and see someone I've missed then please let me know or on here.
    I haven't counted the Gloucester aCFT that is due to be created soon

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  • Ben:
    The missing 3:
    The Princess Alexandra
    Great Western Ambulance (now merged so okay)
    Hinchbrooke (still responsible to TDA and a non-FT).

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  • Am I missing something? The notion of Trust viability is in accordance with an artificial construct created by the NHS and DH through Monitor (CCP and OFT as well) – Tariff, rules for competition, risk rating of Trusts etc. So following the market rules, consolidation, franchising and break up are necessary – almost self fulfilling prophesies, once the rules have been set. It seems clear that with this proportion of Trusts not viable, the model is aimed at reducing the number of hospitals, or the tests are wrong. This outcome however might be right; healthcare has to change its profile of supply. I would question, albeit some might argue the logic and objectivity of the approach, whether this is how policy towards healthcare supply should be made. Whilst there are numerous quality indicators, it does seem (again, maybe rightly) that finance trumps all – should the NHS not be measured as a socio-economic good than a pure economic good? It seems to me that all the current approach is doing is masking the real discussion that should be taking place – which is how does the NHS best provide the service the public wants? For what it’s worth I think there must be a significant core service free at the point of need, but beyond that, co-payment (means tested, as with opticians and dentists now) is possibly the only way to sustain the variety and size of service currently available. The current frippery around “To be or not to be FT?” simply masks that debate.

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  • Hi anon 12:56, I have checked it a couple of times and think I have the number right. But if you look at the spreadsheet attached to the longer version here and see someone I've missed then please let me know or on here.
    I haven't counted the Gloucester aCFT that is due to be created soon

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  • Sorry, not sure why that last appeared twice.
    I've just had another look Anon 3:10pm Princess Alexandra is in there.
    I take your point re Hinchingbrooke but given there's is a 10-year contract under a management franchise I thought having them in would be more confusing than enlightening.
    Anon 3:50pm, I think those are really good points, perhaps I haven't been clear enough that Qs of viability are in a designed-system, not a true market

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  • Should Nottinghamshire Healthcare be on the list?

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  • By 'viability' as an FT trust, this presumably means viable as a profitable business? This obsession with profit-driven back-door privatisation misses the point of the NHS providing a public service for all, which is what it was set up to do.

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  • Steven Burnell

    Not sure how this really works:
    What-if the Aquiring Trust is dragged down? Is it safe to think its Mgt & Culture are strong enough to deliver net gains for all of its Patients?
    Will the synergy of getting rid of any redundant Duplication be sufficient to turn unviable into viable?
    Are we just getting an over-funded Trust to cross-subsidise an under-funded Trust?
    What if a Trust in a geographically remote area is deemed 'unviable' but nobody wants to Acquire it because its inherent business is deemed structurally 'flawed' under prevailing Funding Mechanism - who will serve its Patients?
    In the Commercial arena, a competitor might Acquire a Target just to close it & remove it from the Market, but this might be very problematic for the NHS in many parts of the country outside of a few big cities.
    Can we be Confident only Trusts with demonstrably Safer Hospitals + More Caring Nurses + More Skilled Medics + More Patient-friendly Processes + More Robust Finances will be allowed to acquire a Target?

    So, I wonder what is the underlying problem that the FT Policy is meant to solve:
    Inappropriate Funding Mechanisms?
    Inadequate supply of competent Management?
    Over Capacity to be rationalised by the effects of PFI Policy or non-Tariff Funding versus Clinical Outcomes & Efficiency?
    A lack of Skills, Courage, or Processes to remove unwanted Capacity & Capability by Design?

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  • No Foundation Trust has an independent future.
    All are interdependent.
    All need primary care and the rest of the system if they are to be efficient and effective themselves.
    All are nodes in a network, not stallholders in a marketplace.
    Can we please get back to what unites us, and our common purpose?
    What is the "Foundation"? Isn't it care and compassion, tempered by scientific rigour and financial grip?
    Where is the "Trust"? Isn't it based on communication, collaboration and respect, not competition?
    Human need and suffering are not commodities to be traded.
    We are a service, not a business.
    Can we please put in place leadership that understands this.
    Are Jeremy Hunt and David Cameron listening?

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  • Well said Peter Brambleby

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  • Martin Rathfelder

    Dr Brambley is right. Independence is a delusion in many ways. It's hard to find anyone who believes in it.

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  • Peter B - well said, thank you.

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  • Re-arranging the deckchairs on NHS Titanic while the band plays soothing music in the background....

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  • Ed Macalister-Smith

    The focus in this string of comments has mostly been on the implications for non-FTs, if they are unable to be authorised.

    There is another group of trusts already through the FT gateway that are not viable, and will not be able to survive in their current form. How about a list of them? The public reporting on the Monitor web site of the status of FTs would create that list.

    This is the political challenge that Ministers need to face up to. But as "independent" responsible Boards, their Directors should also have the courage to face up to the challenge, and several seem unwilling to do that...

    And while I am hugely sympathetic to other comments about system, and service, actually having financially unviable institutions in the system is a drain on everyone else's limited resources which is fundamentally unfair, and should be resolved.

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  • Spot on Anonymous 3.50. This financially unviable argument is a false construct designed to drive Trusts into bankruptcy so they can be taken over by multinational healthcare companies.

    The NHS was established for the health of the nation, it is paid for by the people, for the people. It should be managed cost efficiently and clinically effectively. It was doing both before consecutive governments started meddling with it. It should be given back to the people, starting with abolishing the purchaser provider split which is never and was never going to work.

    The stupidity of politicians is one thing, but the failure of those who really understand the NHS to discern the subtleties of the debate is truly astonishing.

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  • Not being facetious 12.05, but what multinational would want to take on a failing organisation? Perhaps the Govt could encourage this by providing additional funding (that could've gone into making them not fail) to get them off the public sector balance sheet, but given the more lucrative/ easier options (the NHS is known as a difficult market) why would they bother? And if a trust is owned by a private company, how would this help GDP?

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