Frequently Asked Questions (FAQs)

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Contents

Background information

What are NHS Foundation Trusts?

Foundation Trusts are membership organisations free from central government control. They are regulated by an organisation called Monitor to protect the public interest. 
If Foundation Trusts make a financial surplus they can invest this in services. Foundation Trusts 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.

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What are the benefits of being a Foundation Trust?

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.

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Are Foundation Trusts outside the NHS?

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 and that is certainly our intention.
They remain part of the public service.

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Does our Foundation Trust status mean more money for services?

The financial regime for all trusts remains challenging and we cannot expect Great Ormond Street Hospital's 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.
Working on a five-year plan gives us more flexibility but it will also increase our financial accountability.

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Membership

What does membership mean?

A Foundation Trust has a membership. Membership is free. Members are drawn from staff, patients and their families; and the general public. Members elect representatives to the Council of Governors. The Council of Governors also consists of representatives from:

  • Commissioners.
  • The local authority (Camden Council).
  • The UCL Institute of Child Health.
  • Voluntary organisations that work with children and families.
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Who is eligible for membership?

  • 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 ten years.

  • Parents or carers of patients seen in the last ten years can be members.

  • If you are a patient or parent/carer member and you were last seen more than ten 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 parent/carer members to be those with more recent experience of our service.
    Please see the section below regarding staff membership.

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What are the arrangements for representing the interests of children?

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 Council of Governors.
We are committed to taking the views of children and young people about what they feel is the best way to be heard.

We want to involve children and young people more and actively listening to their views.

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What benefits does having a membership base bring to a Foundation Trust and what are the benefits of being a member?

Membership offers the hospital 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 Council of Governors 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 they were a non-member.
There are a number of ways we ask for members’ input – through email, post and sometimes through events – and we welcome your suggestions and comments.
Membership offers more formal involvement for everyone 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.

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Staff

What does being a Foundation Trust mean for staff?

Without effective trained and committed staff there are no services. Staff can 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.

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Why should staff be interested?

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.
Foundation Trust status does not solve every problem or remove every challenge, but it is an opportunity to improve things for patients and staff.

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How do staff become members?

Membership works on an "opt out" basis. All GOSH staff who hold permanent contracts and staff on a fixed-term contract of 12 months or more will automatically become members.

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What differences are there between staff that are members and staff that are not?

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 of Governors.

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Do staff still have NHS terms and conditions?

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.

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Council of Governors

What is the role of the Council of Governors?

The Council of Governors 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 Council of Governors:

  • 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.
  • Reflects and involves the users of our services and their families and thus help us to improve their experience.
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What is the Trust Board?

The Trust Board runs the hospital and currently has nine Great Ormond Street Hospital executives on it (Chief Executive, Deputy Chief Operating Officer, Chief Nurse, Medical Director, Director of Human Resources and Organisational Development, Director of Built Environment, Director of Research and Innovation, Director of Communications) 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 four years. They can have two terms.

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What doesn't the Council of Governors do?

The Council of Governors 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.

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How is the Council of Governors made up?

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 Council of Governors is made up of 27 governors:

  • Seven governors elected by the public constituency.
  • Four governors from the patient constituency.
  • Six governors from the parent and carer constituency.
  • Five governors from the staff constituency.
  • Five governors appointed by partner organisations.

We believe that this is a manageable and optimum number of governors, given the size of the Trust and its national profile. The composition aims to be representative of the communities served by the Trust.

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What do I need to be aware of if I’m considering being an elected governor?

Elected governors serve for three years at a time and can serve six years in total.
You must be a member, and aged over 16 years old on the closing date for nominations to be nominated as a governor. There are some legal exclusions; Please see below for details. Elected governors are unpaid (but can claim basic travel expenses and meals).
We will provide assistance for people who may need help with childcare to participate.
Governors elected in the staff constituency are permitted reasonable time off work to fulfil their role as governor. 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.

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What are the exclusions?

To consent to nomination and agree to stand for election to the Council of Governors 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 five 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 three 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.
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What commitment is required as a governor?

The Council of Governors meets five times a year and we hope governors will also be willing to work with other groups. There are 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 governors will need to stay in touch with those who voted for them. Governors will keep members informed of decision making through a regular news update. We will run surveys and events to help governors stay in touch with members.

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What do we hope to get from governors?

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.

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What do we hope our governors will get from being part of the Council of Governors?

We hope that governors get:

  • A chance to contribute to our future.
  • An opportunity for personal development.
  • An opportunity to get involved in something interesting and enjoyable.
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What is the elections timetable?

Our current Council of Governors was elected in February 2018.

Our next election is due to be held in 2021.

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How does the Council of Governors work in practice?

The Council of Governors includes a wide range of people. We 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.

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Broader financial and governance issues

What happens if there are further policy changes within the NHS when we are in the middle of a five year business plan?

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.

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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. 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.

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What role does Monitor, the body that regulates Foundation Trusts play?

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.
As a Foundation Trust we no longer report to the Department of Health. We do not expect there to be a great deal of difference in terms of financial checking between Monitor and our regulator before we became a Foundation Trust and the financial checking we do now. Although there may be fewer hurdles to getting new projects approved, helping us to move quicker in the direction we wish to go.

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What is the composition Monitor and what level of authority do they have?

Monitor reports annually direct to Parliament.

For further information, visit their website at http://www.monitor-nhsft.gov.uk/index.php

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How will the removal of the private patient cap affect our plans?

The Health and Social Care Act 2012 removed the private patient cap, which capped the income Foundation Trusts could receive from treating patients.

Great Ormond Street Hospital is proud of the work we do for the NHS and for private patients. Our private work is largely international, with families funded by foreign governments and healthcare systems to receive care not otherwise available to them. Revenues generated by this can only be reinvested to the benefit of NHS patients. This is currently less than 10 per cent of our total clinical income.

The lifting of the private patient cap will allow us, as a Foundation Trust, to treat more patients but also, through reinvestment, to help more NHS patients as well. However, we will continue to see ourselves as primarily an NHS hospital.

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Can I help or get involved?

Public queries or offers of help

Email foundation@gosh.nhs.uk
You can join as a Foundation Trust member, or find out more on www.gosh.nhs.uk/foundation.

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Staff queries or offers of help

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