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Foundation Trust status makes no difference to performance

FT status itself does not explain difference in hospitals’ performance

Adrian O'Dowd

Monday, 11 July 2011

Hospitals that have become foundation trusts are not any better in productivity or performance than regular trusts because of their FT status, concludes a new report.

The report published by the University of York’s Centre for Health Economics (CHE) found that giving hospitals greater autonomy might not lead to enhanced productivity and performance.

Research carried out by the Centre found that although foundation trusts generally performed better against some key financial and non-financial indicators than non foundation trusts, the difference was not due to their foundation trust status and the differences were long-standing and existed prior to the reform.

For the report Do Hospitals Respond to Greater Autonomy? Evidence from the English NHS, the researchers tracked performance over the last seven years and the results showed that in recent years the performance of both groups of hospitals has tended to converge with any original differences diminishing as a result.

Foundation trusts were introduced in 2004 and are still central to the present government’s plans to liberate the NHS from top-down control. The government expects the majority of remaining hospitals will become foundation trusts by 2014 as a means to secure quality, innovation and productivity and thus improve outcomes.

The CHE team compared the performance of hospitals that became foundation trusts with those that did not, using data spanning a seven year period, pre and post-reform.

The analysis focused on some key measures of financial performance, clinical quality, patient safety as well as staff satisfaction.

CHE director Professor Maria Goddard said: “Our research basically shows that the policy of greater autonomy seems to have made no difference. Some hospitals were better than others to begin with and over time they have all converged and there is no longer any differential performance apparent.

“The governance arrangements for foundation trusts have not been a costless activity. Investment has been required to establish new regulatory structures in order to monitor them. These costs cannot necessarily be set against expectations of enhanced performance.

“Reducing the role of state involvement in public sector services is part of a broader strategy and may well bring wider benefits to communities, but it is not a costless activity. The governance arrangements for foundation trusts have not been trivial and investment has been required to establish new regulatory structures in order to monitor them.

“The experience in the health sector suggests that such costs cannot necessarily be set against expectations of enhanced performance.”

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