FT report by abstraks


									Appendix 1 of Board report ref WL867

  Foundation Status – your questions answered

  This paper compliments the November 2005 Board paper on Foundation Trust Status (ref. WL844)
  and the slide show from the December 2005 Board workshop. It aims to capture the questions and
  issues raised by Board members.

  Ref Question/issue raised                                             Answer                                      Answer ref.
    1 Is there a minimum           There is no minimum or maximum number of members
      or maximum                   required
      number of members
      required in a NHSFT?         The Trust Board can influence the number of members through
                                   the eligibility criteria agreed in the Trust‟s constitution. The
                                   proposed eligibility criteria will form part of the Trust‟s Governance
                                   proposals in the public consultation.
                                   For example, the Trust might propose to set an age limit for
                                   membership at say 14 yrs. Trusts also have the opportunity to
                                   propose that certain groups, e.g. staff, all become members
                                   unless they choose to opt out.

                                   The only fixed criteria is that the following 3 groups are
         How do people             represented; staff, patients and public and partners.
         become members?
                                   “Eligibility for membership of an NHS Foundation Trust will be                  Document 1
                                   open to:                                                                        Page 16, 2.6
                                        1)       members of the public, people who live in the local area and
                                                 people who live outside that area but have been patients in the
                                                 previous 3 years and parents or guardians of children who
                                                 have been patients,
                                        2)      employees of the Trust,
                                        3)      the representatives of partner organisations on the Board
                                               of Governors.”
                                   “There will be no limit on the number of people who can register as             Document 1
                                    members if they meet the eligibility criteria.”                                Page 16, 2.10

     2 Is it the membership        Clinical need is based upon clinical assessment of the needs of the
         who defines needs?        individual service user and linked to evidence based practice.

         How do we ensure          “The management Board of an NHSFT will be accountable to the                    Document 1
         that we have a clear      members…first for ensuring that it [the NHSFT] develops in a way                Page 17, 2.11
         vision/strategy?          that is consistent with the needs of its community of stakeholders
                                   in the local health economy and the wider NHS.”

         How do we ensure          “Monitor will engage in discussions with key stakeholders such as               Document 6
         that we have a clear       the SHA and PCTs, to establish the extent to which the Business                Page 45
         understanding of the      Plan reflects local and regional health economy
         whole health economy?     needs. In particular, Monitor will check that stakeholders have
                                   supported the strategy.”

         How do we ensure we       Stakeholder engagement during the development of the Trust‟s
         have engaged              strategy as well as consultation upon our service development plans
         commissioners?            within our business plan will thus be crucial.

     3   How do you ensure you     The effectiveness and representation of the Board of Governors is
         have an effective and     reflective of Trust‟s constitution and the way membership is recruited
         representative Board of   and managed.
                                   “At the time of application, the size and composition of the Board of           Document 1
                                   Governors will be set out and must ensure that the full range of                Page 10, 1.26
                                   members‟ interests are represented, with a proper balance between
                                   different interest groups within the membership, and that
                                   arrangements are workable in practice.”

             Appendix to Foundation Status January 2006 Board Report: Lesley Stephen, Director of Strategy Performance
Appendix 1 of Board report ref WL867

                                      “The circumstance of each NHS Foundation Trust will be different.              Document 1
                                      The basic framework will be laid down in new legislation and will require:     Page 18,
                                                the overall majority of places to be reserved for representatives   2.17
                                                elected from the patient and public membership, and
                                               the balance of places to include: representatives from the
                                                 employee membership, people nominated to represent partner
                                                organisations, or lead commissioners for specialist services
                                                and universities with responsibilities for undergraduate training
                                                 and research activity in the NHS Foundation Trust.”

                                      “…it may be better to establish divisions of the Board which relate            Document 1
                                       directly to different geographical communities and/or different facilities.   Page 19,
                                      In this way the local community will have direct involvement in the            2.21
                                       governance of a particular hospital even though the hospital is part of a
                                      larger NHS Foundation Trust serving a wider geographical area.”

                                      “It will be up to the NHS Foundation Trust to arrange the election             Document 1
                                      process in whatever way best fits its local circumstance, the only             Page 20,
                                      requirement being that elections are fair and transparent.”                    2.27

                                      “Prior to authorisation, Monitor will require the declared election results.   Document 6
                                       This will enable Monitor to assess whether the Board of Governors             Page 33,
                                      offers a balanced representation.”                                   

                                      “The Countess of Chester NHS Foundation Trust has six staff                    Document 2
                                      governors to ensure that all the main staff groups are represented.            Page 45,
                                      Three of the governors are nurses or midwives as they make up 56%              4.2
                                       of all staff.”

     4   Can a member of staff        “…members of the public and patient constituencies [not staff                  Document 2
         staff become a               constituencies] are eligible for appointment as non-executive directors,       Page 25,
         non -Executive or chair?     including as Chair, on the board of directors.                                 3.4

                                      “At least three governors [must be] elected by members of the staff            Document 2
                                      constituency.”                                                                 Page 42,
                                      “The Chair is the chair of the public benefit corporation. S/he is a non-      Document 2
                                      executive and must meet requirements for non-executive directors.              Page 71,
                                      The chair is not a governor.                                                   6.1

     5   Can members of an            Yes members and organisations can complain about a NHSFT direct to
         NHSFT complain               Monitor. It is however envisaged that the Board of Governors should be
         directly to Monitor about    able to resolve the issue first. Organisations can comment on a NHSFT‟s
         the governance of the         performance but do not necessarily have a right to „enforcement‟.
         Trust?                       Further details of bodies with statutory enforcement powers, and a
                                      statutory role but no enforcement are available in document 3, page 9.
         Do complaints about
         governance of the Trust      Monitor themselves only have the legal right to intervene and take action
         have to be presented to      with an NHSFT in accordance with a set criteria of „significant‟ scenarios
         the Board of Governors?      which are pre-defined document 3, page 24.

         Nb this question was         “In normal circumstances the Independent Regulator will have no reason         Document 1
         raised in the context of     to intervene in an NHSFT‟s affairs. But he or she will have clearly defined    Page 12,
         broad complaints about        step-in powers if there is evidence that an NHSFT is in breach of its         1.33
          the running of the Trust,    licence conditions.”
         not individual service
         user complaints which        “Intervention could be triggered by the Board of Governors of an NHSFT.        Document 1
          would still be handled      The Board of Governors will have a general duty to inform the ”                Page 30,
          as per the current          Independent Regulator of any action by the Management Board that               3.36
          Trust policy.               appears inconsistent with its licence.

             Appendix to Foundation Status January 2006 Board Report: Lesley Stephen, Director of Strategy Performance
Appendix 1 of Board report ref WL867

                                    “It is in the first instance the responsibility of the Board of Directors of       Document 3
                                    NHSFT to remedy any particular compliance failures.”                               Page 7,
                                                                                                                       1.2.3 para 18

                                    “Monitor will make a case-by-case determination, examining the                     Para 19
                                    circumstances to decide what action, if any, is appropriate.”

                                    “Monitor will also take into account any exception or third party reports          Document 3
                                     regarding significant issues.”                                                    Page 8, 1.3.1
                                                                                                                       Para 30
     6   What is the process for    Terms and conditions will not directly be affected with NHSFT status. As
         the removal of staff,      part of the Integrated Business Plan comprehensive HR strategies have
         especially Executive       to be developed by the Trust.
         Directors and Non-
         Executive Directors, if    “The change of legal status to NHSFT will not disrupt continuity of service.       Document 1
         an NHSFT is failing in      Existing terms and conditions will be preserved and staff directly                Page 13, 1.38
         it's service delivery of   employed by an NHSFT will have access to the NHS pension scheme
         key NHS targets?           and associated benefits on the same basis as NHS employees.”

                                    “Employment practices will be an important part of the assessment                  Document 1
                                     process for applicants. Applicant NHSFTs will be required to set out their        Page 40, 6.5
                                    proposed approach.”

                                    “The transition from NHS Trust to NHSFT status will be in line with TUPE           Document 1
                                    and existing staff will move across to an NHSFT without detriment.”                Page 41, 6.8

                                    “If Monitor is satisfied that an NHSFT is failing to comply with the               Document 3
                                    Authorisation, or any requirement it has under any relevant legislation,           Page 24, 3.1.1
                                    and that failure is „significant‟, or that the NHSFT is likely to repeat an        Para 92
                                    earlier failing, Monitor has the discretion to use significant powers….
                                    The powers available to Monitor include; the removal of any or all of the
                                    directors or members of the Board of Governors and appoint interim
                                    directors or members of the Board of Governors.”

                                    “Depending on the severity of the breach Monitor may invoke its                    Document 3
                                    statutory powers of intervention including;                                        Page 27, 3.2
                                                                                                                       Para 105
                                        ● appointing interim directors to oversee implementation of an agreed
                                          action plan: for example in cases where Monitor considers that the
                                          Board in its current form requires additional, skilled personnel to
                                          address the specified issues;

                                    ●    suspending all or some of the powers of Board members and
                                         assigning them to specified individuals or removing Directors or
                                         governors: for example in cases where the performance of individual
                                         executives or directors has, in Monitor‟s considered view, directly
                                         contributed to the significant breach.”

                                    “In addition, the Independent Regulator may specify certain things that the        Document 2
                                    Board of Governors should or should not do if he has cause for concern.            Page 44, 4.1
                                     He may remove all or some governors in cases of the NHS Foundation
                                    Trust failing.”

     7 Where will commercial        The Trust needs to ensure that it has the right mix of skills on its Board to
       acumen come from?            meet the challenges of NHSFT status. The Trust should train and invest in
                                    its members. Monitor will assess the competencies of both Executive and
         Will the competencies       Non-Executive Directors thoroughly through interviews and a „Board to
         of Executive and Non-      Board‟ in phase 3 of the application. The Trust could fail its FT application if
         Executive Directors be     Monitor do not believe the Board has the right mix or level of competencies.
         assessed?                  Monitor can request that Executive and Non-Executive Directors are
                                    removed from post.

             Appendix to Foundation Status January 2006 Board Report: Lesley Stephen, Director of Strategy Performance
Appendix 1 of Board report ref WL867

                                 “An NHS Foundation Trust is required to operate in an efficient and                 Document 2
                                 effective manner. This will require some thought about the resources                Page 73, 7.1
                                 needed to ensure directors and governors are skilled to carry out their

                                 “The Trust Board is required to self certify that it believes that the senior       Document 6
                                  management, (executive directors and their direct reports), have the               Page 34,
                                 capability and experience needed to deliver the strategy.”                

     8 What are the benefits     It is for the Board to determine the benefits of NHSFT status for West
       of FT?                    London Mental Health Trust, its staff, service users and partners.

       How can it improve care   Applicants for NHSFT status must prove to Monitor that;                             Document 6
       for our patients?              “they are providing high quality services that meet or exceed                  Page 2,
                                         national targets and standards
                                             “they have a robust 5-year Business Plan to continually improve
                                               the services they deliver to patients in ways consistent with the
                                                direction of travel set out in Creating a Patient-led NHS.”
                                             “they are financially sound, providing efficient services and a good
                                               return on taxpayers‟ investment.‟”
                                             “they are working collaboratively with local partners, such as PCTs,
                                              in the best interests of their local health communities.”

                                 “Key benefits, NHSFTs are:

                                            accountable to local people, who can become members or                  Document 6
                                             governors. The governors have a duty to appoint non-executive,          Page 6,
                                             Directors, enabling local ownership and service influence whilst        2.2
                                             maintaining local accountability

                                            free to retain and build up surpluses that they generate and decide
                                             how to use these funds for the benefit of patients, service users
                                             and the communities they serve;

                                            able to borrow from commercial sources within the limits set by
                                             Monitor, but their capital requirements are not subject to central
                                             determination or prioritisation;

                                             able to more easily restructure and modernise in order to
                                             increase service capacity and efficiency.”

                                 “NHSFTs will be part of the NHS and subject to NHS systems of                       Document 1
                                 inspection. They will treat NHS patients according to NHS                           Page 3,
                                 principles and NHS standards, but they will be controlled and run locally.”

                                  “It is not the NHS values that need to change, but the NHS in its                  Document 1
                                 organisation, the way it treats its staff, its responsiveness to patients, it‟s     Page 5, 1.2
                                 accountability to local people – feel too much like a 1940s system trying
                                 to deliver 21st century care.”

                                 “Whitehall has too much power. Communities have too little power. Staff             1.3
                                 often feel change is something which is done to them rather than done by
                                 them. A national health service employing over 1 million people cannot
                                 be run from Whitehall. Standards need to be national but controls need to be

                                 “Investment has to be matched by reform…. Reform has to happen on the               1.6
                                 ground it has to be inspired by local innovation and initiative.”

                                 “Reforming the NHS follows the four principles which the government                 Document 1
                                 established for public services:                                                    Page 6, 1.9

           Appendix to Foundation Status January 2006 Board Report: Lesley Stephen, Director of Strategy Performance
Appendix 1 of Board report ref WL867

     8 Continued                             establishment of explicit national standards and clear
                                              accountability for NHS care
                                             greater devolution of power and responsibility from the DH to
                                              clinicians and managers who are responsible for care on the front
                                             more flexibility for NHS staff
                                             greater diversity of provision and choice for patients”

                                 Benefits for patients and the public
                                          “Social ownership of local hospitals with rights to elect Governors.” Document 1
                                          “Local decisions more responsive to community and individual          Page 7, 1.15
                                             patient needs.”
                                          “Greater diversity and choice of healthcare within the NHS.”
                                 Benefits for staff
                                          “Freedom to deliver healthcare without direction from Whitehall.”
                                          “Opportunity to develop locally based services with rights to elect
                                            staff governors.”
                                          “Access to additional rewards linked to the success of the
                                 Benefits for the organisation
                                          “Focus on delivering results which matter for local people rather
                                             than being managed from the centre.”
                                           “Freedom to innovate in service delivery, asset use and human
                                          “More options for capital funding.”
                                 Benefits for the NHS commissioners
                                          “Primary care trusts represented on the Board of Governors.”
                                          “More transparent, delivery focused relationship with providers.”
                                          “Clarity on where money is going and what for.”

                                 “FTs set their own strategy and make their own decisions within the                  Document 8
                                  framework of their contracts with their purchasers. NHSFTs can borrow               Monitor
                                  commercially, retain surpluses and invest to serve local needs.”

                                            “NHS foundation trusts can invest in new patient care facilities, enter   Document 8
                                             partnerships with Primary Care Trusts to manage chronic disease          Monitor
                                            better or develop long term care facilities. They can form
                                            partnerships with the private sector, alliances with other hospitals
                                             or specialise in selected services. They can also hospitals
                                            innovate and bring to England models of care that have worked
                                            in other countries. They can set local targets in consultation with
                                            their members. In all of these areas, NHS foundation trusts are
                                            free to determine how they wish to improve patient services through
                                             innovation and investment .”
                                            “An increased ability to plan and develop services, making quicker        Document 8
                                             decisions on operational issues, for example, setting-up specialist      HCC
                                            community teams.
                                           Focused investment on issues important to patients, such as
                                           physical environment.
                                           Maintained standards of care and pathways of care.
                                           Continued investment in education and training.”

                                 “Membership status will strengthen efforts to provide service                        Document 4
                                 users with meaningful voice, and reduce objectification of service users.”           Page 13
                                  “Freedom from DH/SHA bureaucracy makes it easier to pursue innovative
                                  plans with divestment proceeds.”
                                  “Move to FT status will involve tightening contracting arrangements and so
                                 will reinforce robust relationships with commissioners. “

           Appendix to Foundation Status January 2006 Board Report: Lesley Stephen, Director of Strategy Performance
Appendix 1 of Board report ref WL867

     9   What will be different     " They [NHSFTs] have an independent Board of Governors which appoints            Document 3
         when we are a               a Chairman and other non-executive Directors, and which also approved           Page 4, 1.1.1
         Foundation Trust?          the appointment of the Chief Executive.”

                                    “NHSFT will be different from NHS Trusts in 3 important ways. They will:         Document 7
                                       1)   have new freedom to decide locally how to meet their obligations;        Page 6, 3.3
                                       2)   be accountable to local people, who can become members or
                                       3)   be authorised and monitored by an Independent Regulator.”

                                    “AN NHSFT…will have increased financial freedoms in 3 key areas:
                                        1)  to retain proceeds from asset disposals;
                                        2)  to retain any operating surplus;
                                        3)  to access capital from public and/or private sector sources.”

    10   NHSFT status will require The application process for FT status is 18 months from expression of
         a change in how the       interest to authorisation, in our application December 2005 to July 2007.
         Trust operates. How can
         we prepare for this?      “Improved organisational development and understanding. Potential benefit:        Document 9
                                    The NHSFT application process requires the articulation of a trust‟s strategy    Page 11
                                   and business planning. The main outputs of the process are:

                                    ●Integrated business Plan with outputs on strategy, planning, HR and
                                    ● Financial  model showing cost and working capital projection for five years
                                     into the future.
                                    ● Supporting Board Memorandum and signed statements.
                                    Source of improvement:
                                     The NHSFT application process presents an unprecedented opportunity for
                                    a trust to shape and develop its strategy. Questions to be discussed by trust
                                    management could include the following:
                                    ● Where are you now?
                                    ● Where do you want to be?
                                    ● Which resources do you need to get there?
                                    ● How will you achieve it?
                                    The process gives trusts an opportunity to develop strategy which represents
                                    the views of commissioners, staff and users.
                                    The Board also has the chance to increase its business and management

    11 What is the liability        “There will be a legal lock on their assets to protect NHSFTs from the sort of   Document 1
       of members for capital       „de-mutalisation‟ we‟ve seen in the Building Society sector or any future        Page 3
       borrowed?                     threat of privatisation.”

                                    “The members of an NHSFT will collectively be its legal owners. This is real     Document 1
                                    and not a paper exercise in social ownership. As such the rights of              Page 17, 2.5
                                    membership will therefore confer some limited but real legal responsibilities.
                                    The registered members will be „guarantors‟ of an NHSFT. This means that
                                     if the organisation became insolvent and had to be wound up its members
                                    would each be liable under the terms of the NHSFT constitution, to pay a
                                    nominal sum, (£1) towards outstanding liabilities.”

    12   Importance of using        Agreed.
         process to get close to
         our service users
         therefore can be useful.

    13   Could payment by           “Until PbR is rolled out, [to mental health trusts], PCTs may scale back MHT     Document 4
         results be a derailing      funding in order to pay for increasing acute PbR obligations. If PbR system     Page 15
         issue?                     is poorly implemented, MHT‟s financial stability may be threatened.”

                                    However, NHSFT status offers a legally binding contract including:

             Appendix to Foundation Status January 2006 Board Report: Lesley Stephen, Director of Strategy Performance
Appendix 1 of Board report ref WL867

    13   Continued
                                  “For PCTs:                                                                      Document 10
                                    ● Agreeing in principle to the applicant Mental Health NHSFT‟s three year
                                    ● Agreeing a reasonable amount of notice (i.e. at least 12 months) to give to
                                    the NHSFT should the PCT want to negotiate a change in funding;

                                    ● Working under the assumption that Mental Health NHSFTs will not be
                                    able to manage any reduction in income without a reduction in volume of
                                    ● Adhering to a Mental health inflationary uplift figure set by the
                                    Department; and
                                    ● Working with the Mental Health NHSFT to ensure that income can be
                                    managed in a more transparent way and therefore can make informed
                                    decisions on future planning.

                                  For applicant Mental health NHSFTs:
                                    ● Ensuring that the systems to support the negotiations of commissioning
                                    services are transparent;
                                    ● Developing cost and volume systems on services where there are
                                    financial risks attached;
                                    ● Producing evidence to support the decision of how an identified surplus
                                    can be used for future planning; and
                                    ● Working with PCTs to ensure financial challenges can be foreseen
                                    upstream to assist informed decisions on future financial and service

                                   Ref risk of stability of funding flows through transition to PbR: "DH will work   Document 4
                                   with PCTs and applicant Trusts to ensure that there is a level of stability and   Page 5
                                  therefore reduce that level of risk for mental health NHSFTs."                     DH response
                                                                                                                     to Monitor

    14   How does NHSFT status    There has been no direction to date that disqualifies mental health trusts
         affect the high secure   with high secure services from becoming an NHSFT.
         sector?                                                                                                     Document 6
                                  “Trusts that operate a high secure hospital should provide details of;             Page 32, 5.3.1

                                             the trust's licence for the provision of high secure facilities,
                                             including the expected renewal date and a description of the
                                             process for renewal;
                                             the current system for managing risks at the high secure hospital,
                                       how the Secretary of State‟s line-of-sight to the hospital‟s operation will
                                       be maintained after authorisation;
                                             details of any concerns raised by high secure commissioners and
                                       how these will be addressed;
                                             how key performance indicators relating to the high secure hospital
                                       will be monitored and managed after authorisation.”

                                  “Our policy on funding for specific costs related to Safety and Security           Document 4
                                  remains the same for all those Trusts which have high secure hospitals.            Page 5 DH
                                  NHSFTs with high secure hospitals should not be treated differently, and           response to
                                  should receive the same support as NHS Trusts. “                                   Monitor

                                  Ref Benefits of licensing high secure facilities as FTs:
                                  “Some opportunity for clinical innovation and income streams appear very           Document 4
                                  secure allowing stable basis for a large part of the business, there may also      Page 21
                                  be synergies with other parts of the Trust…..There are still indirect benefits for

    15   How will the Strategic   The process of development of the S.O.C will remain largely unchanged.
         Outline Case (S.O.C)
         play out under NHSFT

             Appendix to Foundation Status January 2006 Board Report: Lesley Stephen, Director of Strategy Performance
Appendix 1 of Board report ref WL867

    16 Will NHSFT status mean There will be more opportunities for collaboration with joint ventures and
       a move from collaboration partnership working
       to competition – a change
       in culture?               “It is my belief that developing an application for NHSFT status offers us    Document 7
                                 opportunities to extend the work which we are already doing to make our       Page 10
                                 services more patient-focused, and to make the Trust more open and
                                 accountable. We are firmly committed to involving our communities, staff and
                                 partner organisation in how we manage services and develop them so far that
                                 they are responsive to the needs of our patients. “Dr Jonathan Michael, Chief
                                 Executive, Guy‟s and St Thomas‟ Hospital NHS Trust, 2003.

    17 FT status could help with    NHSFT status does present an opportunity for joint ventures as discussed
       integrated care with         above in response to question 8.
       voluntary sectors, e.g.
       provide housing and
       employment etc…
    18 What will be the impact of   This requires further exploration, which will be undertaken as part of the
       changes to other public      P.E.S.T. analysis in developing the strategy.
       and voluntary sectors?

       Is there new legislation
       governing voluntary
       How does this link to FT?

    19 Is £0.5m the true cost of    Estimated budget based on learning from other Trust applications to date: 3
       the FT application           main areas of spend:
       process?                             1)    Accountancy consultants are required by the DH to ratify
                                            2)    Legal costs, e.g. to ensure constitution and contracts are legal.

                                             3)   Admin e.g. to manage membership

                                    The Department of Health does provide an element of funding towards these
                                    costs. The budget for the NHSFT status application process will need to be
                                    approved by the Board as per the process with all other cost pressures within
                                    the Trust.

    20 Choice of timing rather      The Trust Board agreed at the November 2005 Board to apply in wave 4, May
       than going through the       2006. The only remaining wave, 4a, is just 6 months behind.
                                    10 Mental Health Trusts have already applied in waves 2 and 3, including
                                    CNWL and SLaM in London.

                                    “The Government‟s aim is that by 2008 all NHS Trusts will have reached a          Document 7
                                    standard which would enabl e them to apply for NHSFT status. “                    Page 4, 1.10

            Appendix to Foundation Status January 2006 Board Report: Lesley Stephen, Director of Strategy Performance
Appendix 1 of Board report ref WL867

      1.   Department of Health, A Guide to NHS Foundation Trusts, 2002.
      2.   Department of Health, NHSFT: A guide to developing Governance arrangements, September 2004.
      3.   Monitor, Compliance Framework, March 2005.
      4.   Monitor, Determining an assessment framework for Metal health Trusts, July 2005.
      5.   Sainsbury Centre Policy Paper, The Future of Mental health: a vision for 2015, January 2006.
      6.   Joint Monitor and Department of Health, Applying for NHS Foundation Trust Status,
          A Guide for Wave 3 Applicants, November 2005.
      7.   Department of Health, A Short Guide to NHS Foundation Trusts, 2003.
      8.   Board paper November 2005, ref WL844, Foundation Trust Status: Background and Application
          Process, Director of Strategy and Performance.
                    Monitor quote from Compliance Framework, March 2005.
                    HCC quote from Healthcare Commission‟s review of NHSFTs, July 2005.
      9.   Joint Monitor and KPMG: a paper on Mental Health Trusts.
      10. Department of Health letter to SHA CEs covering the 5 wave 2 MH NHSFT applicants.

           Appendix to Foundation Status January 2006 Board Report: Lesley Stephen, Director of Strategy Performance

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