If you have a question that is not answered here, please contact us.
Background information
Membership and Members' Council
Staff
Membership benefits
Members' Council
Broader financial and governance issues
Can I help or get involved
Background information
Foundation Trusts are membership organisations free from central government control. There is an independent regulator called Monitor to protect the public interest.
If Foundation Trusts make a surplus they can invest this in services. At present if GOSH makes more money than it spends, the surplus can be taken back by the NHS. Foundation Trusts also have more freedom to borrow for capital projects like new buildings.
Foundation Trusts have to deliver on national targets and standards like the rest of the NHS, but they are free to decide how they achieve this.
Becoming an NHS Foundation Trust allows Great Ormond Street Hospital to retain its independence and thus able to protect our exclusive focus on children’s healthcare needs.
Furthermore, we recognise additional benefits that arise from Foundation Trust status:
- Becoming a membership organisation helps us to extend the range of work we do to find out and act on the views of our patients, their families and the general public. As an NHS Foundation Trust, there will be formal structures to involve these groups and other stakeholders. We will also seek new ways to actively involve young people and their families in our decision making.
- The increased freedom that comes with Foundation Trust status allows us to investigate how we can meet wider public health objectives – specifically around childhood illnesses and overall child health.
- Greater financial flexibility will allow us to seek wider funding options for our work and support our mission to deliver world class and pioneering clinical care and research and to collaborate with others to share that knowledge.
By independence we mean remaining as a standalone children’s hospital and avoiding being merged with a Trust which mostly treats adults.We aim to become a Foundation Trust by spring 2012.
We aim to become a Foundation Trust by spring 2012.
NHS Foundation Trusts have more freedom to decide how to run their affairs and deliver services. We will use our NHS Foundation Trust status to move more rapidly in the direction we wish to go – delivering world class services under new models of care, and retaining our position as a pre-eminent centre for paediatric treatment, research and training.
The membership side of being a Foundation Trust will deliver better patient, family and public engagement.
No. Foundation Trusts are part of the NHS and committed to its core principles of treating NHS patients according to clinical need, free at the point of delivery.
In general Foundation Trusts have continued to work cooperatively with other NHS partners in the best interests of patients. That is certainly our intention.
They remain part of the public service.
The financial regime for all trusts remains challenging and we cannot expect Foundation Trust status itself to provide extra income. Although we can borrow to invest, we would need to be able to repay the loan and interest. It does mean that if we get our costs under control and our strategy right, we will gain money to invest in clinical innovation and better services for patients, which is what we all want.
We still propose to fundraise the remaining costs of the redevelopment but Foundation Trust status would give us more flexibility in getting there.
Working on a five year plan gives us more flexibility but it will also increase our financial accountability.
The hospital will have a Board, Chief Executive and executive directors as it does now.
It should mean less bureaucracy. We cease to be supervised day to day by our Strategic Health Authority and the Department of Health. The public interest is protected by the regulator, Monitor, which checks we run the services we are required to run, that our finances are sound, and that we run ourselves properly. They are much less concerned about the detailed decisions we make on services.
We will be helped by a new body, the Members' Council. We think talking and listening to our families is positive, not bureaucracy.
The Government has said that all hospitals will become Foundation Trusts, or be part of one. If we are not able to become a Foundation Trust on our own we will be merged with, or taken over by an existing Foundation Trust. This would mean the loss of our independence, and our ability to focus on services for children. We would have to compete for funding and resources with a range of other services in a much larger organisation.
Membership and Members’ Council
A Foundation Trust has a membership, which elects representatives to the Members' Council.
Various other interests will be appointed to the Members' Council including:
- Commissioners
- the local authority (Camden Council)
- the UCL Institute of Child Health
- voluntary organisations that work with children and families.
Membership is free. Members will be drawn from staff; patients and their families; and the general public.
Public membership is limited to people who live in England and Wales.
Patient members need to have been seen in the hospital within the last six years.
Parents or carers of patients seen in the last six years can be members.
If you are a patient or parent / carer member and you were last seen more than six years ago, we will transfer you to be a public member. Why? Because we’re keen to make sure that you’re still involved, but we want patient and public members to be those with more recent experience of our service.
Please see the section below regarding staff membership.
This is a very important issue and one which we must get right. Membership will be open to children over the age of 10.
Young people will need to be over the age of 16 to be elected to the Members Council.
We need to move from ‘consulting’ – here is what adults think so what do you think? – to more participation and open listening.
We are committed to taking the views of children and young people about what they feel is the best way to be heard.
Most Foundation Trusts are positive about the experience. Moorfields and the Royal Marsden Hospital, both specialist Trusts with regional and national responsibilities, speak highly of the extra opportunities to develop and improve their services.
Currently, Foundation Trusts have their private patient income capped, so that Foundation status prevents them concentrating on non-NHS work. Most of Great Ormond Street's international and private patient income comes from treating patients who cannot get treatment in their own countries, paid for by foreign governments and healthcare systems. The income from this work allows us to invest in NHS services and to treat more NHS patients.
The Government's Health and Social Care Bill proposes to remove the cap. We will review our plans for the development of international services in the light of any change, but will always remain focused on providing NHS services.
Staff
Without effective trained and committed staff there are no services. Staff will gain new involvement in developing our strategy through staff membership. We want to consult staff in what they want to achieve and what is currently making that difficult.
Foundation Trust staff remain NHS staff with NHS terms and conditions and retain access to the NHS Pension scheme. The Trust might have more freedom in how it meets national agreements and protocols. Like all NHS Trusts in London we are constantly striving to recruit, retain and advance our staff.
The Trust will have an open debate about its HR strategy as we move towards Foundation Trust status.
The Trust proposes that for representation purposes, staff are those ‘integral to the operation of the Trust’
Those on GOSH permanent contracts will automatically become members. Those on short term contracts of 12 months or more and those staff that work with GOSH, such as fundraising charity GOSHCC; the staff at our school and the social workers on our site, contractors such as cleaners and security; and our volunteers working on site may also become members where they have been working with Trust for 12 months or more.
We regret that the legislation prevents some staff with contracts less than 12 months from joining the staff constituency, but they are able to join the public constituency and have a voice and we will encourage staff representatives to seek their views. We will communicate these issues clearly to all staff at the necessary point to avoid confusion.
Great Ormond Street will in no way discriminate against staff who choose not to become members, however staff who are not members will inevitably have less opportunity to get involved in the running of the Trust in the same way. Significantly, they will not be able to vote in the election of their colleagues to the Council.
GOSH has no plans to change Agenda for Change and the Knowledge Skills Framework. There will be no changes to the arrangements for pay or other terms and conditions of employment.
The Trust is open to all ideas about how it might take forward staff recruitment, development and retention. The Trust would need to be delivering a sustainable long term surplus for reinvestment before it could seriously consider paying bonuses. We have reservations about this as a model for incentivising staff but will listen to any arguments presented.
Staff membership represents a new opportunity to comment on the long term financial and clinical strategy for the Trust.
It is a chance for staff to support independence, excellence, and focus on children.
No-one pretends Foundation Trust solves every problem or removes every challenge but it is an opportunity to improve things for patients and staff.
Membership benefits
Membership offers us the following benefits:
- Broad representation of the children and families we work with will help us to better understand their needs in all aspects of our service to them.
- It will also strengthen our advocacy for all children, but particularly sick children.
- GOSH already seeks to value, involve, and develop our staff, who are committed to the organisation and its values. We believe staff membership, by offering greater involvement in our strategic direction and purpose, will reinforce this sense of staff ownership.
We see the membership through the Members' Council as being one guardian of the values of the organisation, ensuring that it operates as it should and in compliance with its authorisation
The benefit we offer therefore is the right to participate and be consulted, to advise and counsel. In essence a member will get more information and more opportunity to comment and be involved than they would if a non-member.
There are a number of ways we will ask for members’ input – through email, post and sometimes through events – and we welcome your suggestions and comments.
Staff membership offers more formal involvement to frontline staff and an additional route to engage with and shape the strategic direction of the Trust. In turn, this will help provide a sense of ownership for strategy.
Members' Council
The Members’ Council has various statutory duties to do with appointing the Chair and other non-executive directors, approving the appointment of the Chief executive, receiving accounts and appointing auditors.
The Members' Council:
- Works with the Trust Board and advises the hospital on strategy and priorities, to make sure that we are tackling what's important for our patients and their families.
- Helps us get our members involved in the work of the hospital, and to recruit more members.
- Holds the organisation to account, by making sure that we do what we say we will do.
- Guards the values of the organisation, so that we always put the child first and always.
- The key role will be to reflect and involve the users of our services and their families and thus help us improve their experience. It will be a critical friend and a guardian of our values and purpose.
The Board runs the hospital and currently has six GOSH executives on it (chief executive, deputy chief executive, chief nurse, chief finance officer and two medical directors) and six non-executive directors (the Chair and five others) who are paid part time outsiders appointed to provide external expertise and to keep an eye on the broader public interest. The Chair and non-executive directors are appointed for a term of 4 years. They can have two terms.
What doesn't the Members' Council do?
The Members' Council does not get involved with the day to day running of the hospital or spend money. Nor does it deal with individual complaints by staff or families.
The membership community is made up of four constituencies – public, patient and carer, staff and partners. Each constituency will elect or select its representatives.
In total, the Members’ Council will be made up of 30 councillors:
- Seven people elected by the public constituency
- Four patients from the patient, parent and carer constituency
- Six parents or carers from the patient, parent and carer constituency
- Five from the staff constituency
- Eight appointed by partner organisations.
We believe that this is a manageable and optimum number of councillors, given the size of the Trust and its national profile. The composition aims to be representative of the communities served by the Trust.
Elected councillors serve for three years at a time and can serve six years in total.
You have to be a member, and aged over 16 years old on the closing date for nominations to be nominated as a councillor. There are some legal exclusions. Please see below for details. Elected councillors are unpaid (but can claim basic travel expenses and meals).
We will provide assistance for people who may need help with childcare to participate.
Councillors elected in the staff constituency get reasonable time off work for their work as councillor. It’s the same arrangement as a trade union representative, with reasonable time off agreed with your manager.
It is an important role but you’re not financially responsible if something goes wrong.
To consent to nomination and agree to stand for election to the Members’ Council it is necessary to declare that you are not:
- a person who has been adjudged bankrupt or whose estate has been sequestrated and (in either case) has not been discharged;
- a person who has made a composition or arrangement with, or granted a trust deed for, his creditors and has not been discharged in respect of it;
- a person who within the preceding 5 years has been convicted in the British Islands of any offence if a sentence of imprisonment (whether suspended or not) for a period of not less than 3 months (without the option of a fine) was imposed on him;
- excluded by any other provision detailed within Annex 6 of the Trust’s constitution. A copy of the constitution can be downloaded here.
The Members’ Council will probably meet four times a year but we hope they will also be willing to work on other groups. Some of these meetings will be on Saturdays. There will be documents and reports to read before meetings. There will be a time commitment, but we know that everyone is busy with other activities (work, school, college, social life etc.!) so we are realistic about how much of this can be done.
Elected councillors will need to stay in touch with those who voted for them. Councillors will keep members informed of decision making through a regular news update. We will run surveys and events to help councillors stay in touch with members.
We hope to get committed people with relevant experience (as a patient, parent or other life experience) who will help fulfil the important role of the Council.
We hope to get people who will use their experience but don’t see themselves as single issue or single department representatives.
We hope that councillors get:
- A chance to give something back and contribute to our future
- An opportunity for personal development
- And we hope it will be interesting and enjoyable.
The elections for the Members' Council were completed on 3 November 2011.
The next full elections will be held in late 2014 /early 2015. There may be elections to fill vacancies before then. Find out more about the election and the results.
This is a new body with a new role. We want our councillors to decide how it should work.
Support is offered. Let us know what help you might need to participate. We are particularly keen to support younger members of the Council such as patients.
The Council will have a wide range of people. We will help the council work together, and work with the hospital management and staff to make sure that we are all aiming to improve things for our patients and families.
We will try and avoid jargon and speak so we all understand each other.
Do let us know any issues or concerns, questions or ideas so we can feed these into our decisions.
Broader financial and governance issues
Being a Foundation Trust will allow us to work to a five year business plan rather than annually. We will be able to absorb policy changes within the NHS better as we can make adaptations over time rather than within each year.
What will happen if as a Foundation Trust we perform poorly financially year on year?
We will be responsible to Monitor for all aspects of our performance, and Monitor is responsible for ensuring Foundation Trusts run efficiently. The application process is rigorous and it is expected that Trusts who are successful will anticipate financial problems and manage them accordingly.
If, after a significant period of time, Monitor felt it was appropriate they may bring in external management to Trusts in the same way as happens currently for ordinary NHS Trusts.
Monitor is primarily interested in whether we are financially robust, legally constituted and well governed. They are less concerned about exactly what service decisions we make. However, they will ensure we run services we are required to run and that we continue to provide the best quality clinical care.
The main difference in the system is that we will not be reporting to the Department of Health. As regulatory bodies, we do not expect there to be a great deal of difference in terms of financial checking, although there may be fewer hurdles to getting new projects approved, helping us to move quicker in the direction we wish to go.
Monitor reports annually direct to Parliament.
For further information, visit their website at http://www.monitor-nhsft.gov.uk/index.php
The overall lead for the project is Jane Collins, Chief Executive.
The application is being managed by Sven Bunn, who can be contacted by email: bunns@gosh.nhs.uk or by phone: x6282.
Can I help or get involved?
Email foundation@gosh.nhs.uk or 020 7239 3131
You can join as an FT member, respond to the consultation or find out more on www.gosh.nhs.uk/foundation.
- HR - Sue Lyon x 1117
- FT Programme Manager - Sven Bunn x 6282
- Staff Side - Adam Levy x 5390
