In 2016/17 NHS England transferred £71.9 billion to CCGs to commission services from Foundation and NHS Trusts.
Foundation Trusts are semi-autonomous bodies not directly accountable to Parliament.
It took years of campaigning to even acknowledge the deaths, neglect and abuse in Staffordshire Foundation Trust, whose public inquiry and insolvency cost the tax payers millions.
Successive governments set target dates for all NHS Trusts to reach Foundation status.
Staffordshire was the ultimate Status that all the expensive management and consultancy aspired to.
Despite Bill Moyes, former NHS Regulator Monitor’s executive chair, urging the NHS in 2014 to reconsider, “whether the model of foundation trusts is sensible”,
“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?”
But still the NHS went on to spend huge sums of public money on merging trusts to gain Foundation status often at the expense of services .
The Department of Health spent nearly £2 billion on 12 mergers alone, compared to £200 million on new care models .
By 2016 the distinction between Foundation Trusts and other NHS trusts had been largely eroded, particularly when their regulators combined to form NHS Improvement .
It appears even after the Staffordshire Scandal and the Francis Report, accountability of NHS services has not improved, as this new overarching body only requires CQC compliance.
Foundation Trusts were created by ‘third way’ Alan Miliburn back in 2002
They were a radical departure from the traditional means by which the NHS was held to account.
Which was directly to the Department of Health and the Secretary of State for Health.
Foundation Trusts are not accountable to Parliament and only to the NHS via NHS England.
So free from political control, and effectively any control other than the CQC and NHS Improvement .
Instead, their accountability is through their local governors.
Governors, who do not have the right to veto individual decisions of a Trust’s Board of Directors.
And the chair of the board of governors is also the chair of the board of directors.
So there is a conflict of interests and this is effectively self regulation..
And the Department of Health does not, in any event, expect the governors to take an active role in the day to day management of the trust, but leave that to the Trust’s management team and the board of directors (Departmentof Health 2003).
The Audit Commission and Healthcare Commission found continued confusion around the role of foundation trust governors, and no significant evidence that they had had an impact on the development of trusts (Audit Commission/Healthcare Commission 2008).
Governors interviewed for another study (Storey et al 2010) reported, that they were easily controlled by the chief executive and the boards of directors, and that their input into the strategic operation of foundation trusts was largely passive, as information receivers, rather than actively shaping the organisation.
The recent history of the NHS suggests that commissioners are relatively ineffective in holding powerful providers to account (House of Commons Health Committee 2010a),
By March 2013 there were 145 NHS foundation trusts (41 of them mental health trusts and five ambulance trusts).
The most lucrative Trusts are the 41 mental health trusts, as nearly a quarter of our NHS budget is spent on mental health.
Most likely, as they are the most profitable services, such trusts as with Sheffield Health and Social Care NHS Foundation Trust has been, will be converted to private companies, with existing Foundation Trust directors made private company directors and shareholders in charge of their own salaries, and effectively through the CCGs the provision of all NHS mentally related services including residential care in their region.
And as Private Companies, they can rely on ‘commercial confidentiality’ to hold the main parts of their meetings in private and as private companies, they are not subject to the Freedom of Information Act.
Yet they still maintain the NHS logo, so no one would, or even could know their services were from a private company..
Nor can there be accountable competition for these services, as Foundation Trusts buy in the services as needed, and are usually, the only ‘specified provider’ within the Health and Social Care Act 2012, the CCGs could use, in fact the Foundation Trusts are even buying up the GP practices that make up the CCGs.
And, as the caption above shows, billions are made just from NHS Trust parking from public land and services.