Mutualising the Public Sector Sue Slipman: Chief Executive, Foundation Trust Network

Reform of Health: Why? Command and control produces lack of ‘consumer’ responsiveness, inefficiency and waste Foundation trust model proved its worth in NHS and all public providers to be FTs and NHS Trusts cease to exist 2016 Growing demand through public expectations demography, technology and life-style Over next 4 years save £20bn : requires disruptive innovation allowing service transformation to deliver more for less in the community and change shape of hospitals Plurality of providers Affordability and quality challenge in health is world wide

Open Public Services White Paper Choice – wherever possible we will increase choice Decentralisation – Power should be decentralised to the lowest appropriate level Diversity – Public services should be open to a range of providers Fairness – We will ensure fair access to public services Accountability – Public services should be accountable to users and taxpayers

Foundation Trusts: Background Set up Health and Social Care Act 2003 Now 140 authorised 130 to go  acute, mental health, ambulance, community Independent of Secretary of State for Health Public Benefit Corporation Unitary Corporate board Accountable:  Nationally to Monitor  Locally: Elected board of governors: 4,000  2m members: patients/service users; public; staff Public sector mutual's with multi-stakeholder accountabilities

FT governors Foundation Trust governors already have considerable power to:  Appoint and remove the Chair and the non-Executive Directors  Have oversight of the Annual Plan  Appoint the auditors and receive their report New ‘powers’  Place duty on unitary board to consult the governors over any transaction or asset leverage over a materiality threshold.  Extend current unitary board’s duty to consult on plan to account to the governors for delivery against plan  Agree constitutional change  Approve significant transactions Duties  Represent members & public

Nature of Foundation Trusts Both ‘incumbents’ and transformational organisations Go-anywhere vehicles: join up services to create value around patient Socially entrepreneurial focus on ‘whole footprint’ Commercially entrepreneurial and innovative Operating at scale Make surplus but reinvest in health and care Will be free to acquire and create their own new assets  End of PPC  No borrowing limits  Easier transactions  Take NHS Brand international

Issue of Employee Ownership Given level of tax payer interest in £28 bn estate, and patient and community interest in services don't believe employee ownership is appropriate in the model- unless it were asset light, but even then questionable given lack of power balance in relationship between patient and clinician.

Good ownership as a model for public sector too See this as a model for the public sector in the future:  Autonomy and localism  Safeguard state assets  Ensure local accountability and engagement  Inject entrepreneurialism and leadership  Mutualisation at scale

Other Models in Pluralist Supply Market Private, for profit Social enterprise Employer owned mutuals Joint ventures Strategic supply chains

Issues Whilst remain hybrid freedom of action for sustainability will always bump in to public expectation. Access to capital Sustainability requires efficient and innovative leadership within a regulatory and funding environment that can challenge but also enables e.g. service reconfiguration So delicate balance that needs careful environment creation.