1. BENEFITS OF BEING A FOUNDATION TRUST PETER HERRING CHIEF EXECUTIVE COUNTESS OF CHESTER HOSPITAL NHS FOUNDATION TRUST

2.  580 bed single-site general hospital  £150m revenue – 2.5 size of Amstrad  3000 Staff  400,000 patients a year  One of first 10 FTs established in 2004 COUNTESS OF CHESTER HOSPITAL NHS FOUNDATION TRUST

3. GOVERNANCE ARRANGEMENTS  Public-benefit Corporation  Independent of government  Board of Directors  Board of Governors  Public Governors  Staff Governors  Appointed Governors  Regulated by Monitor – risk metrics

4. NATIONAL POLICY FRAMEWORK  Independence of service provision  Foundation Trust policy  Private sector providers  PCT provider services  Payment by results  Competitive market economy?

5. FINANCIAL REGIME  Mirrors private sector  Freedom to make surpluses / deficit  Investment income  Capital generated from revenue surpluses, depreciation, access to public dividend capital, borrowing  Tariff variation  Regular surpluses generated  Highest risk rating

6. A CATALYST FOR BUSINESS APPROACH  Profitability  Understanding costs  Productivity, operational & cost efficiency  Viability of services  Financial planning  Risk-based decision-making  Justification of investments  Customer care focus  Incentive mechanisms  Innovative business models  Board skills

7. POLITICAL ISSUES  High level political support  Department of Health uncomfortable  SHAs variable  Uncertainty of independence  Monitor/DOH spat  Cash surpluses  Surplus v quality

8. CONSTRAINTS ON FREEDOMS  National targets and standards  Healthcare Commission/NPSA  Directives through PCTs  New standard contract  PCT/SHA approach  Freedom vs accountability

9.  Responsibilities of independence  Engaging the membership and governors - ensuring local governance adds value  Exploiting the benefits of financial regime whilst maintaining viability  Adapting to dynamic change and shifting tariff  Contracting regime  Achieving cultural change  Delivering real and rapid progress CHALLENGES OF BECOMING A FOUNDATION TRUST

10. BENEFITS OF FOUNDATION TRUST  Freedom of decision-making  Freedom from DOH/SHA bureaucracy  Engagement of local members and governors  Financial freedoms  Development of new business models  Catalyst to business approach