More than half of the community trusts hoping to achieve foundation status have had their authorisation applications delayed, HSJ analysis reveals.
Eleven of the 21 community trusts have either already pushed back their date for submitting a bid to the Department of Health, or anticipate doing so.
The delays cast further doubt over the government’s policy of all NHS trusts being approved as foundation trusts by April 2014.
Factors identified as slowing progress include cuts to their block contract income, uncertainty over the estate they will inherit from primary care trusts, and potential competition under the any qualified provider rules.
Aspirant community foundation trusts were created under the transforming community services programme, when PCTs’ provider arms were split from their commissioning function.
About two-thirds of provider arms were taken over by mental health or hospital trusts with the remaining third becoming independent, either as community trusts or social enterprises.
In September 2011, aspirant community foundation trusts, along with every other non-foundation, had to sign a tripartite formal agreement with the DH and their strategic health authority. This committed them to a date by which they would submit their application to the department, which has to approve them before they are passed to Monitor.
Only three have so far submitted applications to the DH and hit their TFA target. They are: Birmingham Community Healthcare; Derbyshire Community Health Services; and Norfolk Community Health and Care trusts.
Two - Cambridgeshire Community Services and North Staffordshire Combined Healthcare trusts - have already been referred to the DH because of delays. The department may remove board members if it is not satisfied with progress.
Nine more trusts have either already missed their TFA submission dates or indicated they will do. Delays range from one month for Bridgewater Community Healthcare Trust to five months for Leeds Community Healthcare Trust.
A further seven have not yet reached their planned submission date. None of the 21 trusts created under transforming community services have yet been recommended for approval by the health secretary and passed to Monitor for its authorisation process.
The chair of one trust told HSJ a cause of the problems was a delay in formally transferring PCTs’ estates to the trusts. Another was the potential for what the source described as “death by nibbling”, with trusts losing income under AQP competition. The source said another barrier was the foundation trust pipeline process being designed for hospitals trusts, and not fully adapted to the different performance measures and payment systems used in community trusts.
He said the delays were in large part due to “lack of understanding of what community trusts actually do”, although he added that Monitor and the DH were improving their metrics.
NHS Confederation deputy policy director Jo Webber said: “The way the system has been set up does not advantage community trusts.”
A DH spokeswoman said: “Trusts need to demonstrate very high clinical performance underpinned by a business case that’s sustainable well into the future.”
- Andrew Lansley
- Ashton, Leigh and Wigan Community Healthcare NHS Trust
- Birmingham Community Healthcare NHS Trust
- Cambridgeshire Community Services NHS Trust
- COMMUNITY PROVIDERS LIST
- Competition and co-operation
- Department of Health and Social Care (DHSC)
- DERBYSHIRE COUNTY PCT
- Foundation trust pipeline
- NHS Confederation
- NORFOLK PCT
- North Staffordshire Combined Healthcare NHS Trust