Published: 09/09/2004, Volume II4, No. 5922 Page 10 11
It is a fair bet that South Yorkshire will be one of the first health economies to have a full set of non-specialist foundation trusts.
All four of its non-specialist acute trusts boast three stars and the region can already claim two foundation hospitals, Sheffield Teaching Hospitals and Doncaster and Bassetlaw Hospitals.
Rotherham General Hospitals trust, which deferred its foundation trust application in March, still plans to free itself of Department of Health control later this year, while Barnsley District General Hospital trust has just published its plans to seek foundation status.
The remaining acute trust is the specialist Sheffield Childrens trust, which also possesses three stars.
Sheffield Teaching Hospitals foundation trust is the region's largest trust, and the second largest in the country, with 12,000 staff and around a million patients a year. After the initial euphoria of becoming a foundation, the trust is now facing up to the challenges of its status.
'The actual application process made us focus closely on where we were and what we were doing, ' says chair David Stone.
'As a result we have done more forward thinking about the next five years.
'But at ward level I wouldn't have thought there has been that much change yet - and probably not in the chief executive's office either.'
The occupant of that office, Andrew Cash, who also chairs the NHS Confederation's foundation trust network, stresses that change is nothing new to Sheffield's health economy. His trust was created by the merger of two adult trusts in 2001.
Pointing out that Sheffield has been a three-star trust from 2001, Mr Cash says success has come from concentrating on two issues: 'One is performance; if you do not get performance high then you can forget about everything else, and It is the same for a foundation trust.
'The second is the research and development agenda working the city's two universities.'
Mr Cash says the next logical step was to increase cross-boundary working with other NHS and public sector bodies and improve the amount of public involvement - hence the foundation application.
The need for partnership is often stressed in this part of the world. SHA chief executive Mike Farrar attributes the region's success to close working between NHS organisations (see below).
'I think It is very important to say that you have to work together in a system. It is an obvious comment, but in managing an organisation you have to manage the whole system, both here and in primary care, ' says Mr Cash.
'Our five-year plan involves the trust's four main clinical aims: reducing emergency admissions, significantly increasing elective surgical work, more chronic disease work in primary care settings and increasing tertiary work.
'This was developed in partnership with primary care and other hospitals in the area. We are only part of the health economy.'
He continues: 'Foundation trusts are essentially about providing services. Demand has to be handled somewhere else.
'It is not in our interests to bankrupt local PCTs and It is not in their interests to bankrupt the local foundation trust.'
Tackling the daily challenges thrown up by payment by results, which foundations are introducing a year early, is one of the key issues on the trust's agenda.
Questions are still being asked, for example, about whether the system will adequately remunerate the trusts for work carried out.
But the new freedoms accorded to Sheffield Teaching Hospitals also mean there are opportunities to be exploited.
Director of service development Chris Linacre is interested in the new possibilities to work with the independent sector.
'There are huge opportunities that we are just starting to explore, about how we as a foundation trust can work with independent sector providers outside of what I would call the shackles of the national contracts.
'What we are now starting to explore is whether we can work genuinely and constructively with the independent sector to help them with what they are good at doing, ' he says.
This includes, for example, high-volume elective care, perhaps around hotspots like orthopaedics.
The independence of foundation status also allows the trust to pay more attention to local needs: 'While we should have certain national targets, what is right for Whitehall may not be right for South Yorkshire or Sheffield, based on the sort of health inequalities we have.
'We have got all the right sort of people to help run the local regeneration agenda much more accurately, ' insists Mr Cash.
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