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81-590: Bob Piper has been the chairman of the trust since 2004. It became a foundation trust in 2009. Half the board members are black and minority ethnic, the only trust in England to achieve that. The trust was given £89,000 from the Nursing Technology Fund in March 2014 which is to be spent on mobile devices. The trust, together with Dudley and Walsall Mental Health Partnership NHS Trust has set up

162-555: A Liaison and Diversion service. The intention is that "when someone in a police station, or involved in court proceedings, has a mental health problem or other vulnerabilities, they are referred to the right services and are given support and guidance based on their needs." An inspection by the Care Quality Commission in 2016 found that Abbey ward, Charlemont ward and Friar ward at Hallam Street Hospital, West Bromwich all had blind spots. The wards were said to be in

243-569: A limited company owned by the Department of Health. When the white paper was presented to Parliament, the Secretary of State for Health, Andrew Lansley, told MPs of three key principles: The white paper set out a timetable. By April 2012 it proposed to: The Bill foresaw all NHS trusts becoming, or being amalgamated into, foundation trusts . The Bill also abolished the existing cap on trusts' income from non-NHS sources, which in most cases

324-402: A cap on the proportion of their income that can come from non-NHS treatments. It did not only apply to income derived from individual patients, it covered income from all non-NHS sources. This could include joint ventures to develop medical technologies, employers paying for counselling services or income from treating UK military personnel overseas. The Health and Social Care Act 2012 abolished

405-403: A completely new entity." The BMA believes such targets to be either wholly impossible or, at best, able to be done only in a very roughshod manner, which could in turn have very serious on-the-ground consequences to NHS functioning. The British Medical Association opposed the bill, and held its first emergency meeting in 19 years, which asked the government to withdraw the bill and reconsider

486-543: A director of public health, and gives the Secretary of State certain powers over that person's appointment. Sections 181 to 189 establish Healthwatch England , responsible for gathering and championing the views of users of health and social care services in order to identify improvements and influence providers' plans. Sections 194 to 199 establish Health and wellbeing boards in each upper-tier local authority, in order to encourage providers of health and social care to work in an integrated manner. Sections 232 to 249 expand

567-487: A link between the community and the board of directors. The size of the council of governors and its exact composition are determined by the constitution of the particular trust. Each trust adopts its own constitution subject to certain restrictions in legislation. These restrictions include that a majority of the council of governors must be elected governors and governors must be unpaid volunteers. Some trusts are more committed to co-operative principles and have even written

648-840: A new organisation – the NHS Trust Development Authority – was established by the Health and Social Care Act 2012 to supervise trusts which have not reached foundation status, of which there were 99 in April 2013, 47 of which were never expected to reach foundation status. The Health and Social Care Bill 2011 , overseen by Lansley, proposed that all NHS trusts become foundation trusts or part of an existing foundation trust by April 2014. The early foundation trusts were generally financially buoyant, but during 2013 and 2014 more faced financial difficulties. A foundation trust finance facility, managed by an advisory committee to

729-459: A private conference last October. Nor was I given the opportunity to respond ahead of publication. I worked in the NHS for twenty years and now work alongside it. I have always been a passionate advocate of the NHS and believe that it has a great future. Like many other countries throughout the world, the pressure facing healthcare funding and provision are enormous. If the NHS is to change and modernise

810-626: A result of the reforms, with a leaked draft risk-assessment claiming that emergencies could be less well managed and the increased use of the private sector could drive up costs. Various pressure groups opposed the bill, including The People's Assembly, NHS Direct Action, Keep Our NHS Public , 38 Degrees , the Socialist Health Association , many Trades unions, including the Chartered Society of Physiotherapy , UNISON , and Unite . 38 Degrees' petition against

891-591: A shared services solution". By the end of 2013–14, foundation trusts collectively had built up cash reserves of £4.3 billion and it was suggested in the NHS Five Year Forward View that the government would "support" foundation trusts to spend this money "to help local service transformation". In response, the chief executive of the Foundation Trust Network, Chris Hopson, said: "The responsibility for these surpluses lies with

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972-674: A speech, but instead to hold a separate meeting with 40 Conference attendees in a separate space (taken as an insult to nurses, and leading to accusations of 'gutlessness'); and the current separate "efficiency savings" measures being undertaken across the NHS and those actions' material impact on frontline medical services, especially as contrasted with several prominent officials, including NHS leaders and Lansley himself, repeatedly assuring that NHS frontline services are 'protected' at all times regardless of these "savings" measures. "People will die", Richard Horton, editor of The Lancet , warned in March 2012, as he predicted "unprecedented chaos" as

1053-773: A variety of tests, which have changed over time. In 2003 only trusts with three stars from the Commission for Health Improvement were eligible for foundation status. In that year Aintree Hospitals, Essex Rivers Healthcare, Newcastle upon Tyne Hospitals and Walsall Hospitals were all downgraded to two stars and so did not make the first wave of foundation trusts. Formerly referred to as foundation trust equivalent (FTe) instead of Equivalent Foundation Trusts , this designation applies only to trusts providing high secure psychiatric services, of which there are three: Nottinghamshire Healthcare NHS Trust , West London Mental Health NHS Trust and Mersey Care NHS Trust . These trusts abide by

1134-691: A ‘poor state’ with stained and damaged walls, carpets and furniture and an ‘unpleasant odour throughout the ward areas’. They found a number of areas of good practice. "This included how young people were involved in making decisions about their care and that the trust had also employed a nurse who spoke four Asian languages to lead on work with black and minority ethnic communities." It planned to merge with Birmingham Community Healthcare NHS Foundation Trust and Dudley and Walsall Mental Health Partnership NHS Trust in October 2017. The new organisation would have an annual turnover of around £440 million – making it

1215-432: Is a staff constituency, a patient constituency, and a "public member" constituency, consisting of members who are neither patients nor staff but live in a defined geographical area. In addition, there are governors appointed by bodies with whom the trust works in partnership. So, for example, appointments may be made by local councils, local medical schools, and local voluntary organisations. Governors are intended to act as

1296-585: Is described in Schedule 7 of the National Health Service Act 2006 , with the formal corporate form being called a "public benefit corporation". Each foundation trust has a council of governors. This is made up of elected governors and appointed governors. Elected governors are chosen by a secret postal ballot of the membership, which is open to the general public. The elections are usually held in separate constituencies. Typically there

1377-522: Is the bit that has worked best". David Benbow argued in 2020 that the legislation did not extend patient choice as envisaged (as this policy subsequently took a backseat) but that it did lead to an increasing amount of the NHS budget being diverted to private providers. The publication of the NHS Long Term Plan in January 2019 marked the official abandonment of the policy of competition in

1458-649: The Daily Telegraph called the "biggest revolution in the NHS since its foundation". The white paper, Equity and Excellence: Liberating the NHS , was followed in December 2010 by an implementation plan in the form of Liberating the NHS: legislative framework and next steps . McKinsey & Company who have been influential in the British Department of Health for many years was heavily involved in

1539-817: The Alcohol Education and Research Council , the Appointments Commission, the National Information Governance Board for Health and Social Care, the National Patient Safety Agency , the NHS Institute for Innovation and Improvement and the standing advisory committees. Sections 284 to 309 contained various other provisions. On 19 January 2012 two major unions of healthcare professionals that had previously tried to work with

1620-552: The Care Quality Commission , the NHS Commissioning Board, and the economic regulator Monitor . Although the remit of each is set out in legislation, it is not clear how these national bodies will interact or how they will provide coordinated and consistent governance of the NHS." Clinical commissioning groups operate as statutory bodies, though it was suggested that up to third of CCGs are reluctant to do so. The King's Fund said that "the very real risk that

1701-482: The Health and Care Act 2022 . The proposals in the act were not discussed during the 2010 United Kingdom general election campaign and were not contained in the Conservative–Liberal Democrat coalition agreement of 20 May 2010, which declared an intention to "stop the top-down reorganisations of the NHS that have got in the way of patient care". However, within two months a white paper outlined what

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1782-875: The Hospital Universitario Fundación Alcorcón in Spain is thought to have been influential in developing ideas around foundation status. That hospital was built by the Spanish National Health System , but its operational management is contracted out to a private company, and exempt from many of the rules normally imposed on state-owned hospitals, and in particular, that hospital was allowed to negotiate its own contracts with workers. The governance of that hospital includes local government, trade unions, health workers and community groups. Foundation trusts were announced by Health Secretary Alan Milburn in 2002, and

1863-757: The Parliament of the United Kingdom . It provided for the most extensive reorganisation of the structure of the National Health Service in England to date. It removed responsibility for the health of citizens from the Secretary of State for Health , which the post had carried since the inception of the NHS in 1948. It abolished primary care trusts (PCTs) and strategic health authorities (SHAs) and transferred between £60 billion and £80 billion of "commissioning", or healthcare funds, from

1944-620: The Rochdale Principles into their constitution; they aspire to work closely and in partnership with other mutual and local organisations. At first, foundation trusts were authorised and regulated by Monitor , a non-executive body under the Department of Health. Monitor was merged into NHS Improvement in 2016. The trade body for foundation trusts is NHS Providers , formerly known as the Foundation Trust Network, which has 95% of all acute, ambulance, community and mental health foundation trusts in its membership. A 2014 report by

2025-471: The Socialist Health Association said that on the whole after 10 years, "Foundation Trusts [had]... not deepened in terms of democratic practice and participation". The independence of Foundation Trust governors was challenged in 2021 when the governors of Queen Victoria Hospital , a small specialist trust, called for a pause to plans for it to merge with University Hospitals Sussex NHS Foundation Trust . NHS Improvement were said to have effectively ordered

2106-616: The "biggest revolution in the NHS since its foundation". The bill was introduced in the House of Commons on 19 January 2011. In April 2011 the government announced a "listening exercise", halting the Bill's legislative progress until after the May local elections ; the "listening exercise" finished by the end of that month. The Bill received Royal Assent on 27 March 2012. Many of the structures established by this Act of Parliament were dismantled by

2187-489: The Bill becomes law, and would be replaced by a duty on an unknown number of commissioning consortia with only a duty to make or arrange provision for that section of the population for which it is responsible." It replaces a "duty to provide" with a "duty to promote". After an increase in opposition pressure, including from both rank-and-file Liberal Democrats and the British Medical Association ,

2268-643: The Bill on 20 March 2012. The Bill received Royal Assent and became the Health and Social Care Act 2012 on 27 March 2012. Section 9 establishes the National Health Service Commissioning Board, later known as NHS England . The Secretary of State is to publish, annually, a document known as the mandate which specifies the objectives which the Board should seek to achieve. National Health Service (Mandate Requirements) Regulations are published each year to give legal force to

2349-594: The Bill was approved in principle at second reading in the House of Lords by 354–220. An amendment moved by Lord Owen to commit the most controversial clauses of the Bill to a select committee was defeated by 330–262. The Bill was subsequently committed to a committee of the whole House for detailed scrutiny. The committee stage was completed on 21 December 2011, and the Bill was passed by the Lords, with amendments, on 19 March 2012. The Commons agreed to all Lords amendments to

2430-507: The Department of Health definition of a foundation trust, but the Secretary of State for Health maintains a direct line of communication and accountability with them because he or she has the responsibility to provide healthcare to patients who have been detained under the Mental Health Act , and have been judged to pose a grave and immediate danger to the public. Unlike full foundation trusts, governors have no statutory role, and

2511-410: The Department of Health was promoting "A new type of NHS hospital". In 2011, the 116 trusts then in the pipeline to make applications were required to sign a formal agreement, with a deadline for the application to be made. Board members at a number of trusts which missed the deadline were sacked. It was accepted by Andrew Lansley that a number of trusts would never reach foundation trust status, and

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2592-429: The Department of Health, was established to process loans for capital developments, but during 2014 applications were made by trusts which had trouble paying utility bills or replacing medical equipment. Guidance issued under the tenure of Jeremy Hunt in October 2014 said that conditions could be set which could include: reductions in the use of temporary staff, "use of collaborative procurement routes" or "the adoption of

2673-470: The English NHS. Integrated care systems would be created across England by 2021, and in 2022 Clinical Commissioning Groups were abolished and NHS Improvement absorbed into NHS England, though all this was intended to happen without repealing the legislation. In February 2019, NHS England produced a document outlining changes it wanted to see in legislation. One of the central proposals was to remove

2754-461: The FTs; any attempt by the statutory bodies to make a grab for them will be furiously resisted". By 2016, the distinction between foundation trusts and other NHS trusts was widely regarded as eroded, and in that year the two regulators were combined into a new body, NHS Improvement . The notion that every trust should become a foundation trust was abandoned, and the widespread financial crisis undermined

2835-493: The Foundation Trust Network it was raised to 1.5%. These caps disappeared on 1 October 2012. Collective earnings from private patients increased 14%, from £346.1 million in 2012–13 to £395.9 million for 2014–15. Private earning is concentrated on specialist hospitals in London who see many patients from other countries. Most trusts have negligible private income. In order to achieve foundation trust status, NHS trusts have to pass

2916-551: The NHS Consultants Association and a consultant clinical oncologist) compared the policies with academic analyses of privatisation and found "evidence that privatisation is an inevitable consequence of many of the policies contained in the Health and Social Care Bill". Lansley said that claims that the government was attempting to privatise the NHS were "ludicrous scaremongering". The proposals contained in

2997-532: The NHS to reconsider "whether the model of foundation trusts is sensible", arguing "If one-third of the hospital system is permanently not demonstrating good viability and good governance, is that telling you something about actually how the system should run as opposed to how we thought it should run?". In January 2022 Sajid Javid , writing in The Times said he was planning a “revolution” that would allow “well-run hospitals more freedom”. Foundation trusts had

3078-494: The NHS will be a state insurance provider not a state deliverer", and emphasised the role of Lansley's reforms in making this possible: "The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years." KPMG issued a press statement on behalf of Britnell on 16 May 2011 stating "The article in The Observer attributes quotes to me that do not properly reflect discussions held at

3159-597: The RCP is concerned that the bill does not require that specialists are at the heart of the commissioning process." The Royal College of Psychiatrists said it "would be dismayed if psychiatrists were not closely involved with local consortia of GPs in the development of mental health services." The Royal College of Surgeons said that "the legislation leaves the question of regional level commissioning unanswered with no intermediary structure put in place." And there were concerns about management expertise, particularly by looking at

3240-733: The US. The BMJ wrote that "No matter how many GP consortiums eventually emerge, their number will probably greatly exceed the 152 primary care trusts they are replacing, which brings a set of new challenges. Smaller populations increase the chances that a few very expensive patients will blow a hole in budgets. More consortiums mean that commissioning skills, already in short supply nationally, will be spread even more thinly. Denied economies of scale, smaller consortiums may be tempted to cut corners on high quality infrastructure and management, thereby endangering their survival. These points emerge clearly from an examination of 20 years of US experience of handing

3321-535: The abolished PCTs to several hundred clinical commissioning groups , partly run by the general practitioners (GPs) in England. A new executive agency of the Department of Health , Public Health England , was established under the act on 1 April 2013. The proposals were primarily the result of policies of the then Secretary of State for Health, Andrew Lansley . Writing in the BMJ , Clive Peedell (co-chairman of

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3402-497: The act were some of the coalition government's most controversial. Although mentioned in the Conservative Party's manifesto in 2010, they were not contained in the Conservative–Liberal Democrat coalition agreement , which mentioned the NHS only to commit the coalition to a real-term funding increase every year. Within two months of the election a white paper was published, outlining what The Daily Telegraph called

3483-461: The best provider to deliver healthcare services, whether they are a private company or a charity, will spur innovation and choice." In May 2011, a number of doctors from GP consortia wrote a letter to the Daily Telegraph in which they expressed their support for the bill, calling its plans "a natural conclusion of the GP commissioning role that began with fundholding in the 1990s and, more recently, of

3564-641: The bill. In February 2011 David Bennett , newly appointed Chair of Monitor , said the NHS could become like other privatised utilities, so that Monitor would potentially be a regulator like Ofcom , Ofgem and Ofwat : "We, in the UK, have done this in other sectors before. We did it in gas, we did it in power, we did it in telecoms […] We've done it in rail, we've done it in water, so there's actually 20 years of experience in taking monopolistic, monolithic markets and providers and exposing them to economic regulation." The House of Commons Select Committee on Health condemned

3645-408: The board of directors have no statutory duty towards the governors. The governors cannot, without the board of directors' permission, have any control over the direction of the trust, and cannot appoint or remove trust auditors. The chair and directors are not appointed by their board of governors. Health and Social Care Bill 2011 The Health and Social Care Act 2012 ( c 7 ) is an act of

3726-409: The comparison as not "accurate or helpful." The bill intended to make general practitioners the direct overseers of NHS funds, rather than having those funds channelled through neighbourhood- and region-based primary care trusts , as was previously done. There were concerns about fragmentation of the NHS and a loss of coordination and planning. The Royal College of General Practitioners said it

3807-550: The council of governors to work towards a merger. A study undertaken in 2005 by the King's Fund of Homerton University Hospital NHS Foundation Trust found some governors disappointed and disillusioned. Another report in 2005, funded by the Nuffield Foundation , found that it was too easy to invite members to sit on sub-committees, where they quickly became bogged down in the minutiae of operational planning, whilst

3888-690: The discussions around the Bill. The bill was introduced into the House of Commons on 19 January 2011 and received its second reading, a vote to approve the general principles of the Bill, by 321–235, a majority of 86, on 31 January 2011. The act had implications for the entire English NHS. Primary care trusts (PCTs) and strategic health authorities (SHAs) were abolished, with projected redundancy costs of £1 billion for around 21,000 staff. £60 to £80 billion worth of commissioning will be transferred from PCTs to several hundred clinical commissioning groups , partly run by GPs. Around 3,600 facilities owned by PCTs and SHAs would transfer to NHS Property Services ,

3969-525: The equivalent of commissioning budgets to groups of doctors. Some groups had severely underestimated the importance of high quality professional management support in their early days and gone bankrupt as a result." The House of Commons health committee has suggested the government let experts other than the consortia GPs and their direct allies get involved in the running of the consortia, including hospital doctors, public health chiefs, social care staff, and councillors. That idea received some wider support and

4050-402: The establishment of a Citizens' Panel to report on how easy it is to choose services, while patients would be given a right to challenge poor treatment. The original Bill sought to abolish two tiers of management and hand power to new bodies led by GPs, called commissioning consortia, to buy £60 billion a year in treatment. Professor Steve Field , a GP who chaired the forum, said many of the fears

4131-430: The government agreed to give it consideration. Those close to Health Secretary Andrew Lansley have said that he is concerned adding too many people to consortia decision-making risks making them too unwieldy." In 2010 the same committee had gone so far as to declare that "if reliable figures for the costs of commissioning prove that it is uneconomic and if it does not begin to improve soon, after 20 years of costly failure,

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4212-511: The government announced a "listening exercise" with critics. On 4 April 2011 the government announced a "pause" in the progress of the Bill to allow the government to 'listen, reflect and improve' the proposals. The Prime Minister , David Cameron , said "the status quo is not an option" and many within his and Nick Clegg 's coalition said that certain aspects of the Bill, such as the formation of Clinical commissioning groups , were not only not open for discussion, but also already too far along

4293-531: The government on the bill, the Royal College of Nursing and the Royal College of Midwives , decided instead to join with the British Medical Association in "outright opposition" to the bill. On 3 February 2012 the Royal College of General Practitioners also called on the Prime Minister to withdraw the bill. The Confederation of British Industry supported the bill, declaring that "Allowing

4374-534: The legislative basis was the Health and Social Care (Community Health and Standards) Act 2003 . The first ten NHS hospitals to become foundation trusts were announced in 2004. Gordon Brown prevented plans by Alan Milburn that they should be financially autonomous in 2002. By 2012, the Monitor website listed 145 foundation trusts. Successive governments set target dates by which all NHS trusts were supposed to have reached foundation status. For example, by 2009

4455-524: The main decisions were taken at meetings that they only heard about after they took place. The public's perception of foundation trust status implying a high standard of clinical care was changed by the Mid Staffordshire NHS Foundation Trust scandal of the late 2000s ( Stafford Hospital Scandal ) and the ensuing Francis inquiry , published in 2013. At the outset, some critics claimed that foundation trusts went against

4536-548: The mandate. Section 10 establishes Clinical Commissioning Groups which are to arrange the provision of health services in each local area. Section 11 makes the protection of public health a duty of the Secretary of State, and section 12 makes local authorities responsible for improving the health of the people in their areas. Among the effects of this, local authorities regained the commissioning of some community services such as those for sexual health and substance misuse . Section 30 requires each local authority to appoint

4617-564: The party would repeal the Health and Social Care Act in "the first Queen's Speech" if elected. In January 2015, Chris Ham and others from the King's Fund produced a review of the government's health reforms. Their conclusions as far as the act was concerned were that: In November 2017, Jeremy Hunt in an interview with the Health Service Journal said "The idea of lots of competing foundation trusts and payment by results works well when you have in your mind that most of

4698-421: The path to completion to be stopped. Cameron insisted that the act was part of his " Big Society " agenda and that it would not alter the fundamental principles of the NHS. Part of the "listening exercise" saw the creation on 6 April 2011 of the "NHS Future Forum". The Forum, according to Private Eye , "brings together 43 hand-picked individuals, many of whom are known as supporters of Lansley's approach". At

4779-553: The plans". The Royal College of General Practitioners (RCGP) also denounced the bill. The Royal College of Physicians and Royal College of Surgeons welcomed in principle the idea of medical professionals determining the direction of NHS services, but questioned the Bill's implementation of the principle, particularly in regard to the approach of making GP consortia the primary commissioning deciders, and also in regard to requiring competition. The British Medical Association said similarly. Neither of these organisations supported

4860-408: The previous government's agenda of GP polysystems and practice-based commissioning". On 14 May 2011, The Guardian published an article reporting that the GP appointed to head the NHS "listening exercise" has unilaterally condemned the bill. The article said that Steve Field had "dismissed" the plans "as unworkable" and that these statements were "provisional conclusions that could fatally undermine

4941-533: The private patient income cap but FTs have to do the majority of their work for the NHS. This restriction was kept to reassure those concerned about future developments that FTs would continue to have NHS work as their central concern. Previously each FT had its own cap, set at the level of its private activity when the first FTs were established in 2003/4. About three-quarters of all FTs had a cap of 1.5% or less. Until 2010 all mental health trusts were completely barred from undertaking non-NHS work, but after lobbying from

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5022-437: The privatisation agenda." On 9 October 2011, a protest organised by UK Uncut took place on Westminster Bridge . an estimated 2,000 health workers and activists attended the protest. On 5 March 2012, the campaign group 38 Degrees erected 130 billboards in the centre of London with the aim of persuading David Cameron to abandon the bill. On 25 September 2013 Labour's shadow health secretary Andy Burnham promised that

5103-426: The public and medical profession had about the Health and Social Care Bill had been "justified" as it contained "insufficient safeguards" against private companies exploiting the NHS. Following the completion of the listening exercise, the Bill was recommitted to a public bill committee on 21 June 2011. On 7 September, the Bill passed the House of Commons and received its third reading by 316–251. On 12 October 2011,

5184-412: The public sector and less autonomous than was originally expected. By March 2013 there were 145 foundation trusts, of which 41 were mental health trusts and three were ambulance trusts. They included acute trusts, mental health, community and ambulance trusts. By March 2019, the number of foundation trusts had shown a small increase to 151. The basic governance structure and form of foundation trusts

5265-564: The public, private and voluntary sectors will all need to play their part." In June 2011 Cameron announced that the original deadline of 2013 would no longer be part of the reforms. There would also be changes to the Bill to make clear that the main duty of the health regulator, Monitor, was to promote the interests of patients rather than promoting competition. The Future Forum report suggested that any organisation that treats NHS patients, including independent hospitals, should be forced to hold meetings in public and publish minutes. It also wanted

5346-474: The purchaser/provider split may need to be abolished ." Kieran Walshe , professor of health policy and management and Chris Ham , chief executive of the King's Fund , argued that "At a national level, it is difficult to see who, if anyone, will be in charge of the NHS. There will be five key national bodies: the Department of Health , the National Institute for Health and Clinical Excellence ,

5427-534: The reforms passed 250,000 signatures by 21 April 2011. In March 2011 a motion at the Liberal Democrat spring conference called for changes to the Bill to ensure greater accountability and prevent cherry-picking by private providers, among other demands aimed at reducing marketisation of the NHS. UNISON sponsored rapper NxtGen to create an unflattering hip hop track about the bill, which has now been viewed over 390,000 times on YouTube. Jeremy Hunt

5508-575: The reforms, although a motion of no confidence in Andrew Lansley by the BMA failed. A later motion of no confidence in Lansley at the Royal College of Nursing Conference in 2011 succeeded, with 96% voting in favour of the motion, and several speeches thereafter condemning Lansley threefold: the Health and Social Care Bill 2011 as written; Lansley's decision not to address the entire Conference with

5589-575: The role of the National Institute for Health and Clinical Excellence to include social care, re-establishing the body on 1 April 2013 as the National Institute for Health and Care Excellence (known as NICE). This non-departmental public body publishes guidance in areas such as the use of new and existing medicines, treatments and procedures, taking into account cost-effectiveness; its scope is NHS services, public health services, and (in England only) social care. Sections 278 to 283 abolished

5670-424: The same time, David Cameron set up a separate panel to advise him on the reforms; members of this panel include Lord Crisp (NHS chief executive 2000–2006), Bill Moyes (a former head of Monitor ), and the head of global health systems at McKinsey , as well as Mark Britnell , the head of health policy at KPMG . Six months previously Britnell had told a conference of private healthcare executives that "In future,

5751-401: The speed and scale of the reforms could destabilise the NHS and undermine care must be actively managed." The BMJ said in January 2011 that "The bill promises that all general practices will be part of consortiums by April 2012, yet it took six years for 56% of general practices to become fundholders after the introduction of the internal market. Nearly seven years after the first NHS trust

5832-620: The spirit of the principles laid out by Aneurin Bevan , the founder of the NHS. Others feared that it would lead to a two-tier system. Others doubted whether foundation trust members would succeed in having any effective influence over hospital management. In 2011, some argued in a report financed by the Nuffield Foundation that the success associated with foundation trusts had been due to other factors than governance. In June 2014, Bill Moyes, former Monitor executive chair, urged

5913-476: The supposed autonomy when almost all had to rely on money borrowed from the Department of Health, to which strings were attached. Foundation trusts have some managerial and financial freedom when compared to NHS trusts . The introduction of foundation trusts represented a change in the history of the National Health Service and the way in which hospital services are managed and provided. At

5994-604: The third biggest mental health trust in England. The three way merger collapsed but the merger with Dudley and Walsall is still planned for 2020. Foundation trust An NHS foundation trust is a semi-autonomous organisational unit within the National Health Service in England . They have a degree of independence from the Department of Health and Social Care (and, until the abolition of SHAs in 2013, their local strategic health authority ). As of March 2019 there were 151 foundation trusts. Alan Milburn 's trip in 2001 to

6075-542: The time of introduction, they were described "as a sort of halfway house between the public and private sectors". This form of NHS trust is an important part of the United Kingdom government's programme to create a "patient-led" NHS with an internal market . The stated purpose is to devolve decision-making from a centralised NHS to local communities, in an effort to be more responsive to their needs and wishes. But after Gordon Brown prevented plans by Alan Milburn to make them financially autonomous they have been much more in

6156-434: The work the NHS does will be single episode elective care, but when you're dealing with complex patients who are going in and out of the system a lot those structures prove not to be fit for purpose." Nick Timmins , writing in 2018, concluded that the legislation, in its own terms, had failed. Choice and competition were not, as envisaged, the driving principles of the NHS. In fact the development of integrated care systems

6237-413: Was "concerned that some of the types of choice outlined in the government's proposals run a risk of destabilising the NHS and causing long-term harm to patient outcomes, particularly in cases of children with disabilities, those with multiple comorbidities and the frail and elderly." The Royal College of Physicians said that "Whilst we welcome the broad provision in the bill to seek professional expertise,

6318-499: Was appointed Health Secretary in a cabinet reshuffle on 4 September 2012, succeeding Lansley. He had previously co-authored a book calling for the NHS to be dismantled and replaced with a system of personal health accounts. The deputy chairman of the British Medical Association, Kailash Chand, said "Jeremy Hunt is new Health Secretary – disaster in the NHS carries on. I fear a more toxic right winger to follow

6399-532: Was granted foundation status, there are still more than half to go—within two years. And there's more. The replacement for the 10 strategic health authorities—the NHS Commissioning Board—needs to be fully operational by next April. By then, GP consortiums should have developed relationships with local authorities, which will assume ultimate responsibility for public health via their new health and wellbeing boards, working alongside Public Health England,

6480-418: Was previously set at a relatively low single-digit percentage. Under the Bill's provisions the new commissioning system was expected to be in place by April 2013, at which time SHAs and PCTs would be abolished. The Bill was analysed by Stephen Cragg of Doughty Street Chambers, on behalf of the 38 Degrees campaign, who concluded that "Effectively, the duty to provide a national health service would be lost if

6561-494: Was unpicking the "purchaser/provider" split that had been the dominant theme of NHS management since 1991. The organisations set up by the act, Monitor and the NHS Trust Development Authority had effectively been merged. And there was nothing to suggest that "political micro-management" and "excessive bureaucratic and political control" had disappeared. However, he said the act had given the NHS an independent voice, and that according to Jeremy Hunt "the independence of NHS England

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