1. NHS Foundation Trusts and Changing the Market Structure : Some Messages Malcolm Lowe-Lauri CEO, King’s College Hospital NHS Foundation Trust

2. The Policy Origins of NHS Foundation Trusts
Break through change through supply side deconstruction
New market entrants
Primary care providers
Independent Sector Treatment Centres
Tentative deregulation of NHS hospitals
Account to regulator
Compensated for work done
Keep profits
Borrowing powers
Account to communities, with limitations
To sit alongside other policy changes, especially Patient Choice and Payment by Results

3. How have Foundation Trusts performed?

4. How have Foundation Trusts performed?

5. How have NHS Trusts performed?
Significant variations though recent marked improvement
Clusters of deficit e.g. Outer S.E. London
Some correlation with clinical quality and safety issues
Aggravated by asset renewal through the Private Finance Initative
With more pressure – legal, financial – to come

7. Responses: consolidations and planning solutions
Acquisition of Good Hope Hospital by Heart of England F.T.
Pre-acquisition discussion in Cambridgeshire, but FTs are cautious
‘Darzi’ plan for London challenging the District General Hospital concept
Darzi now going national with Next Stage Review

8. The challenge for Commissioners
This is historically a supply-led environment
The commissioning unit – the Primary Care Trust – has been undersized and underpowered until recently with a dramatic ambition to world class
It must battle pork barrel politics and strong local sentiment
So, FTs may have an emerging leadership role

9. The Academic Health Sciences Centre Question
Applies to FTs and non-FTs
The current university hospital lacks scale
The pricing system for NHS services lags behind innovation
We need to compete globally
Academic funding streams are currently unstable

10. So whither an Academic FT?
Consolidations to create AHSCs
Novel partnerships to support own service delivery
Novel partnerships to support struggling hospitals – new role for the private sector?
Power in the investment potential of FTs to support policy
But of course when it comes to professional perspectives, politics and transition costs it’s not as simple as that!