The Changing NHS

The NHS currently has 65 Foundation Trusts (FTs), employing approximately 220,000 staff. The idea is that these organisations, usually secondary care acute providers, freer from central control, will be both more effective and more active 'players' in helping to reshape the NHS provider landscape.

In an earlier post I talked about 4 strategic mindsets that FTs might hold. I’ve now 'polished this up' a bit and so I'm re-posting, as I think the mindsets, as described in this post, are more accurate.

The 4 mindsets are not all mutually exclusive but I wonder how well a FT can pursue more than one of these successfully at the same time. They are as follows:

1. Compete with ‘Look Alikes’
This mindset is often the most prominent one amongst managers at the outset of a Trusts’ journey to FT status. Usually, by the time the application process is complete, views have migrated to number 2 below, but some still retain this mindset and many may well return to it once they feel more confident. Here, the FT continues to seek to provide a comprehensive range of local services whilst also growing quickly by winning market share from neighbouring acute trusts that are believed to be in a weaker position in certain service lines. To do this well it needs to act quickly, before other Trusts get their act together and before PCTs become better at ‘market’ management.

2. Refocus on Core Business
This is the most common mindset to be adopted once a Trust becomes a FT. Driven, in large part, by fear of becoming financially unstable and thereby falling foul of Monitor, the independent regulator, this type of FT quickly decides to stop pretending that it can be good at everything and seeks to re-focus on what it is good at or can produce a surplus from. To do this well it needs to be single minded in seeking to earn a deserved reputation for providing certain services that might, ultimately, lead to higher volumes of core business, possibly via brand extension into other FT and private sector facilities.

3. Be Entrepreneurial
Here the new FT wants to get off the mark quickly by enthusiastically seeking out large numbers of opportunities for creating or contributing to new services and/or niche businesses, often beyond its current portfolio of activity. ‘Let a thousand flowers bloom’ might be the motto. Managers within this kind of FT operate within an earned autonomy regime and, even if only a few ideas are ultimately fully supported, this should quickly give the Trust an interest in several new ‘businesses’. Some of these can then be sold off as going concerns, raising significant income. Ultimately the Trust will probably become a holding company with several operating divisions or it may merge with other FTs.

4. Dive Deeper
Here, the FT believes it can use its resources and talents to help the local health and social care economy become more coherent and efficient. Accordingly, it seeks to exert more influence within the local primary and social care sectors. In its most developed form this mindset suggests a high degree of vertical integration, with groups of GP practices contractually aligned to the FT and community service staff and possibly some local authority staff employed. Ultimately this mindset suggests an FT will have an interest in investing in new sub-acute community-based services, especially those that serve older people with complex co-morbidities, perhaps in partnership with new private sector providers.

Do you recognise these mindsets? Are there others around?  To what extent do you think a FT successfully pursue more than one of these mindsets at the same time?

Steve  

nhs

hospitals

strategy