Foundation Trust Application Progress Report
21 October 2008
1.Background
1.1 West Hertfordshire Hospitals NHS Trust is responsible for health services provided at Watford, Hemel and St Albans hospitals. It employs around 4000 staff working in over 50 different professions to serve the catchment area of west Hertfordshire, with a population of over 500,000 and wider as people choose to attend its hospitals.
1.2 The Trust's key relationships in the delivery of care continue to be with the West Hertfordshire PCT, General Practitioners/Practice Based Commissioners, community based healthcare staff, and local social services.
1.3In July 2008, it was agreed with the East of England Strategic Health Authority (“the SHA”), that West Hertfordshire Hospitals Trust would go ahead with an application to become a Foundation Trust. This was due to the significant improvements in finance and performance targets (see appendix), which was felt to put the Trust in a strong position to succeed.
2.Consultation
2.1The Trust launched its public consultation on becoming a Foundation Trust on 22nd September 2008. The consultation will run for 12 weeks, finishing on 16th December 2008.
There are 5 proposals being consulted on:
Proposal 1:To become a Foundation Trust
Proposal 2: To start Membership at 16
Proposal 3: Three Membership categories of Public, Staff and Out of Area Patient (& Carers)
Proposal 4: Public Governor constituencies boundaries
Proposal 5: Public Governor seat allocation on the Board
3.Membership
3.1 The Trust is planning to have a representative Membership of 5000 public Members prior to our application to Monitor. All staff will automatically become Members with an opportunity to ‘opt-out’ should they wish to do so. Although Membership will start at 16 years of age, there will be an associate membership for those under 16 who wish to be involved
4.Governance
4.1The governance of the Foundation Trust will include a Board of Governors, elected from our membership. The proposal being consulted on is that there will be 26 Governors made up as follows
- 14 Public Governors
- 1 Out of Area Patient (and Carers) Governor
- 5 staff Governors, representing the Staff Members
- 6 Stakeholder Governors representing:
- Primary Care Trust(s)
- Hertfordshire County Council
- Practise Based Commissioners
- University of Hertfordshire
- Eastern Deanery
- Local Involvement Network (LINk)
The number of public governors must be greater than the combined staff and stakeholders.
4.2 It is proposed that the public membership is divided into 6 constituencies and that each of these constituencies will have a number of seats on the Board of Governors in proportion to the number of patients referred to our hospitals. These are shown in table 1 below
Table 1: Proposed constituencies and numbers of Governors
Public Constituency / Number of SeatsSt Albans / 3
Watford / 3
Three Rivers / 3
Hemel Hempstead / 3
Berkhamsted and Tring / 1
Hertsmere / 1
Table 1: Constituency Boundaries and Numbers of Governor Seats
5.Timetable and Next Steps
5.1 The consultation will run until 16 December. The results of the consultation will be used in compiling the Trusts Constitution.
5.2From January until the spring, there will be an iterative period with SHA to confirm they are confident the Trust will succeed. This will be an intense period of scrutiny of the Trusts performance and management along with an evaluation of the business plan and long term financial model to support service delivery going forward.
5.3It is anticipated that the Department of Health Applications Committee will consider the Trust’s application in May 2008. They will then authorise the Trust to proceed to scrutiny by the external regulator, Monitor, who will undertake a rigorous examination of the Trust. The earliest date for accreditation as a Foundation Trust would be in the Autumn of 2009.
5.4In tandem with the Foundation Trust Application is the development of the Outline Business Case for the NewAcuteHospital at Watford, within the Watford Health Campus. Planning permission was granted mid May 2008 and the Highways Agency removed their holding directive and backed the scheme in June 2008. The Public Sector Comparator element of the Outline Business Case is due for completion in July 2009.
5.5The Trust would be happy to report its progress at a future meeting of the Health Scrutiny Committee.
David McNeil
Director of Corporate Affairs
October 2008
Appendix
Key achievements
Healthcare Commission rating
Following the 2 consecutive years of being rated as weak: weak from the Healthcare Commission, a position of one of the 4worst in the country we are confidently expecting to have a rating of fair : fair when announcements are made on 16 October 2008 . Our own assessment of how we are already performing this year demonstrates us working at a consistent good: good.
Finance
In 2006/07 we had a deficit of £11.3m following significant improvements we were able to create a surplus of £2.5m in 2007/08. In 2008/09 we are on course for a surplus of £4m and as a Foundation Trust would have more freedom to invest in locally supported services.
A&E waiting times
In the first 4 months of 2007/08 7% of patients waited 4 hours for treatment in A&E by the end of this year this was reduced to 2% and we are recurrently working at 1%.
18 week referral
In 2006/07 1 in 3 patients not needing admission and 2 in 3 needing an admission waited over 18 weeks. These figures have been reduced to 1 in 50 not needing an admission and 1 in ten who do require admission to hospital
Infections
In 2006/06 the Trust’s Clostridium difficilerates were amongst the worst in England, there has been a 93% reduction in west Herts Hospitals Trust far exceeding the reported national figure of 30%. In addition we have also halved the MRSA cases we have each year.
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