Mark Britnell On foundation trusts

Published: 08/07/2004, Volume II4, No. 5913 Page 15

The announcement of the next wave of foundation trusts by the independent regulator last Thursday was warmly welcomed by University Hospital Birmingham trust, not least because of the sheer amount of effort in our now successful application process over the past year.

It is far too early to tell how these new public benefit corporations will act and perform. But it is clear, as one of our non-executive directors put it, that 'everything and nothing has changed'. This neatly summarises the situation. It has been 'business as usual' since 1 July, but everything has changed in terms of the growing maturation of 'system reform' and the organisational trajectory we are now on.

What have we learnt? Our autumn consultation made us better integrated and sensitised to the needs of our local community.We have also learnt a lot about patient and citizen involvement through our constitution, electoral process and electoral constituencies.We are working with the Office of Public Management to develop each governor in an individualised and collective fashion. They have responded warmly to this programme and we see this as a fundamental part of our rock-solid commitment to constituency participation.

Our board of directors has grown up.With KPMG, we have already completed a skills audit to develop the board on an individual and collective basis.

Executive directors will need to learn how to share information and power appropriately as the entire board accepts new corporate governance responsibilities.

The rigour with which the regulator has assessed our application has given the board a much deeper feel for corporate risk and an acceptance that some internal management systems will need to change. The assessment has driven home the importance of working capital and good cash management.

The role of the chair and chief executive has also changed irrevocably.As accounting officer to parliament, the chief executive officer needs to work with, and through, boards in a way that questions notions of heroic and personalised leadership. Collective accountability coupled with a very high degree of personal responsibility will call for new skills. It is the role of chair that has changed the most: it now has to combine a subtle blend of skills.

Finally, we learn that the Healthcare Commission is already warming up to consider criteria for foundation review! It is too early to gauge success but we have already taken the considered risk with our local primary care trust to open some badly needed emergency beds to reduce occupancy rates and further improve accident and emergency waiting times.Our performance last week stood at 98 per cent. Let us hope that this is a sign of things to come - local need met quickly through new freedoms and sensible decision-making.

Mark Britnell is chief executive of University Hospital Birmingham trust.