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Agenda item Staffordshire Moorlands District Council

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									                                                                      AGENDA ITEM NUMBER: 7




REPORT TO:                                   Board Meeting
DATE OF MEETING:                             6 January 2009
TITLE :          Foundation Trust Outcome of the Public Consultation 1 September to 30          DOC DATE:          December 2008
                 November 2008
1.      EXECUTIVE SUMMARY
The Board need to consider the local level of support for the Trust plans before finalising the long term direction and progressing
to the next stage of application for NHS Foundation Trust status.

The Trust completed the public consultation on proposed plans to become an NHS Foundation Trust on 30 November 2008. The
report sets out for Board Members three key aspects for consideration and decision:

     1. The achievement against the Communications Plan agreed in August 2008.
     2. Outcome of the consultation on plans and proposals for NHS Foundation Trust status.
     3. Recommendations to the Board on the outcome of the consultation and timescale to proceed to the next stage of the
        application process.

1. Report on achievement against Communications Plan

Members are asked to receive the report. More than 15,000 consultation documents were circulated, over 1,800 members of the
public and all UHNS staff were contacted during the consultation period, the communication plan was achieved other than in two
areas.

2. Outcome of the Public Consultation

In summary the Board are advised that overall the respondents may be considered as supportive of the proposals to move to NH
Foundation Trust status with some amendments and assurances around the governance of a future Trust.

The richness of the accompanying comments received both written and as questions during the public and staff sessions, give th
Trust a good measure of what the public and staff feel is critical for the Trust to achieve in the immediate term, and over the next
few years.

In order to build confidence, it is clear that the public will need ongoing assurance in three key areas.

        service quality and performance
        adequate local accountability and controls in place to ensure no future fragmentation of care services
        that decision making and performance reporting are open, subject to challenge and are transparent.

Ongoing demonstration of how the Trust is achieving on these matters in the preparation for, and achievement of NHS Foundatio
Trust status will be critical, so as to embed a new culture as a public benefit corporation accountable to Members and Governors

2.     STRATEGIC/CORPORATE OBJECTIVES SUPPORTED BY THIS PAPER
Partnerships and Social Responsibility – Achieving Foundation status

3.       RECOMMENDATIONS                         (To Note/Receive/Endorse/Adopt/Defer etc)

The Board are asked to determine whether the process described above, meets the first three of the Cabinet Office Cod
of Practice on Consultation and to seek assurance that criteria 4 and 5 will be met in a set time period.

The Board are asked to seek confirmation that a report on effectiveness of consultation is produced to include ho
appropriate representation of minority communities such as ethnic groups, gender, disability and mental health can b
achieved and to incorporate this into a future Membership Strategy.


The Board are asked to consider the following specific matters for decision:

         Challenge – Evidencing accountability and controls to local people. Respondents expressed a range of concerns that in



                                                                                                                       1
achieving NHS Foundation Trust status, the Hospital would be less accountable than at present.

   A specific issue was raised asking the Board to consider holding Board meetings in public once Foundation status is
   achieved. This matter was raised by a local MP, the North Staffordshire Pensioners Convention, the Newcastle unde
   Lyme 50+ group and the Overview and Scrutiny Committees at Stafford Borough Council and Stoke on Trent City
   Council, and individuals.

   Recommendation 1

   In order to build public confidence further, that during 2009 the Trust continue to attend the public forum
   identified and utilised during the consultation period specifically to;

          Feedback directly to these groups on the outcome of the public consultation and changes.
          Provide a direct means of updating the public on the Trust plans moving forward and managing
           questions and concerns relating to the Trust reputation including any issues and media stories.
          Continue to develop methods of engaging with the public and all minority groups to ensure adequate
           engagement in a future Membership Strategy. This action will help the Trust in managing the
           reputation and public confidence, provide evidence of engagement and help to grow accountability
           that will support Membership and Governor recruitment.

       The Trust develop a method of evaluating and reporting the impact of a future NHS Foundation Trust in
       North Staffordshire.

   Recommendation 2

   To change the draft Constitution to show that in addition to all of the Membership Council meetings being
   held in public, there will be quarterly Trust Board meetings held in public. This frequency matches the
   quarterly reporting requirements a future NHS Foundation Trust would be working to.

Challenge to the single Appointed Governor representing Staffordshire Councils, these include Stafford Borough Council
Staffordshire Moorlands District Council and Newcastle under Lyme Borough Council.

       A question has been raised as to how a future NHS Foundation Trust ensures appropriate representation of
       Staffordshire Local Authority services. The Trust proposed one Governor for this area, the respondents have
       challenged this and asked for a representative for the three areas, Stafford Borough Council, Staffordshire
       Moorlands District Council and Newcastle under Lyme Borough Council.

       Recommendation 3

       The Trust cannot offer three Appointed Governor seats to the three Councils without increasing the
       public Governors as this would not meet the legal requirements for the Constitution to have a majority of
       public Governors . Therefore it is recommended that the Trust meet with the three Councils and agree
       appropriate adequate Appointed Governor representation, specifically to ensure adequate Social Service
       engagement in a future Membership Council.

Challenge to the number of Staff Governors representing Medical and Dental Staff

       A couple of respondents have suggested there should be more than one Governor for Medical and
       Dental Staff.

       Recommendation 4
       The Trust do not change their rationale of having one staff Governor for around every 700 staff, this
       equates to one for Medical and Dental staff, and that the rationale is shared with
       those who challenged this.

Changes to the Trust Five Year Plan

       Recommendation 5

     To consider further changes to be incorporated into the Trust Five Year Plan to include



                                                                                                         2
              comments that respondents suggested as additional aims, priorities and achievements in the
              first three years as an NHS Foundation Trust. To report this to the Board on production of the
              updated Plan. To feedback to the public through the programme described in recommendation
              one above.

The Board decision to proceed to the next stage of Foundation Trust readiness assessment.

The outcome of the consultation is generally supportive and therefore would not prevent the Trust continuing with an application
for NHS Foundation Trust status immediately. However, concerns about service performance were expressed in the consultation
process, and the Trust are currently not achieving the service performance targets for the A&E 4 hour wait or delayed discharges
As such it is not possible to recommend progressing until the Board can be assured of sustained achievement in these aspects o
performance.

            Recommendation 6

            To consider proceeding with the next stage of NHS Foundation Trust assessment in June 2009
            in order to demonstrate sustained achievement of all service performance requirements, and to
            note that this would result in the earliest possible authorisation date early in 2010.

4.                              AUTHOR                       OPERATIONAL LEAD                          EXECUTIVE LEAD
NAME               Andrea Green                           Rob Vernon                         Andrea Green
5.      BENEFITS FOR PATIENTS (MEASURABLE INDICATORS ON SAFETY, QUALITY AND EXPERIENCE)
Improving the organisational capability and the local accountability of the Trust should improve the overall service provided for
patients.
6.        DOES THIS ITEM APPEAR ON THE RISK REGISTER?
          Yes                            √       No                     Corporate             √    Divisional
          If no, rationale:

       If so, what level of Residual Risk has been allocated?
                   Consequence                        Likelihood          Risk Score           Level of Risk
       Major                                   Unlikely              8                High
       Risk Description:
       Failure to demonstrate capability to achieve NHS Foundation Trust status
7. TO BE CONSIDERED AT:                                 TRUST         EXEC              OTHER                 OTHER
                                                        BOARD     COMMITTEE          (Exec Team)             (STATE)
DATE:                                               6 Jan 09
OUTCOME                                                                               Approved
Approved/deferred/received etc.
8. HAVE ALL IMPLICATIONS BEEN                       YES      NO  N/A                             YES     NO      N/A
CONSIDERED?
FINANCE                                              X                 DIVERSITY IMPACT           X
NATIONAL POLICY/LEGISLATION                          X                 IM&T                               X
LDP                                                  X                 CLINICAL RISK              X
HR                                                   X                 GOVERNANCE                 X
CONSULTATION                                         X                 OTHER




                Consultation Period and Communication/Engagement Programme



                                                                                                                       3
The Trust commenced consultation on the proposals to achieve foundation status on 1 September 2008 and
finished on the 30 November 2008. This was a 13 week period, a week longer than that required.

    1. Consultation media and presentation

The Trust produced a full Consultation Document and a summary Consultation Document in hard copy,
approximately 15,000 documents were distributed during the consultation period. Both documents and an Easy
Read version, were published on the Trust website, and available in an electronic format, which was used to
accompany letters sent via email, and sent directly to those who requested an electronic version.

Large print copies and a talking book version were requested and produced during the consultation period. A
translation of the document into other languages was offered, however the Trust received no requests for a
translated version.

Public Meetings engagement including the specific Foundation Trust Public Events

The proposals and plans were presented to a total of 928 people at the following public meetings and to individuals
at the FT Consultation events. Every attendee also received a consultation document.

                       Name of Meeting                                           Location              Attendees
Pensioners Convention, 1 September                                  Hanley Museum                                 114
FT Consultation Event, 8 September                                  Bentilee Neighbourhood Centre                  98
FT Consultation Event, 12 September                                 Burslem School of Art                          76
UHNS AGM, 25 September                                              Medical Institute, Hartshill                   35
FT Consultation Event, 29 September                                 Floral Hall, Tunstall                          25
Community Health Voice, 2 October                                   Dresden Street Centre, Hanley                  11
Newcastle Overview and Scrutiny Committee 8 October                 Civic Offices, Newcastle                        5
FT Consultation Event, 13 October                                   Dudson Centre, Hanley                          36
Biddulph Community Focus Group, 9 October                           Biddulph Town Hall                              1
Stafford Overview and Scrutiny Committee 14 October                 Stafford Town Hall                             12
FT Consultation Event, 15 October                                   Methodist Hall, Cheadle                        37
Over 50s Group, 16 October                                          St Giles Church Hall                           35
FT Consultation Event, 20 October                                   Council Offices, Leek                          46
FT Consultation Event, 23 October                                   Gatehouse Theatre, Stafford                    36
FT Consultation Event, 27 October                                   Community Centre, Fenton                       27
Cheddleton & Wetley Rocks Neighbourhood Forum, 3 November           Cheddleton Community Centre                    17
Staffordshire Moorlands Scrutiny Committee, 4 November              Dane House, Leek                               12
Biddulph Neighbourhood Forum, 4 November                            Biddulph Town Hall                             39
Tean Neighbourhood Forum, 5 November                                Christ Church Hall                             25
Leek Neighbourhood Forum, 6 November                                Red Cross Centre                               21
FT Consultation Event, 7 November                                   Holy Trinity Hall, Newcastle                   19
Endon Neighbourhood Forum, 10 November                              Endon Village Hall                             26
Cheadle Neighbourhood Forum, 12 November                            Cheadle Methodist Hall                         18
FT Consultation Event, 13 November                                  Biddulph Council Rooms                         56
Werrington Neighbourhood Forum, 19 November                         Werrington Village Hall                        25
Stoke on Trent Scrutiny Committee, 21 November                      Stoke on Trent Civic Centre                    12
FT Consultation Event, 24 November                                  Walton Community Centre,                       25
FT Consultation Event, 26 November                                  Victoria Hall, Kidsgrove                       21
FT Consultation Event, 28 November                                  Methodist Central Hall, Longton                18

Additional to these events, Trust staff discussed the consultation plans and handed out documents to another 447
people during the FT Consultation events, and plans distributed at other public sessions events listed below.


Name of Meeting                                                                   Location               People
Local Medical Committee                                                Shelton                              14

Neighbourhood Forums and Resident Groups                               Biddulph; Cheadle; Leek;             215
                                                                       Cheddleton; Endon; Tean;
                                                                       Werrington and Porthill.


                                                                                                                      4
FT Stand 2 days in Potteries Shopping Centre                           Hanley                               76

Library Reception (38) and Library staff (50)                          Hanley                               88

Engagement with Young People, Job Seekers and Partners                 Various                              119

Presentation to UHNS Volunteers                                        UHNS, Clinical Education             14
                                                                       Centre

Staff Engagement

Additional to these public events, a number of methods were used to engage staff to raise awareness of the Trust
proposals and plans, these were namely:

Event                                                                       Number involved              When

Staff drop-in sessions, stands and information in staff entrances           5 sessions               October and
                                                                                                      November

Executives attendance at staff meetings explaining the plans and taking     35 sessions across       September to
questions                                                                   all sites                 November

CEO personal letter and copy of the consultation documents                  All staff on payroll     Beginning of
                                                                                                      September

CEO personal letter and request to advise by 30 November if not wanting     All staff on payroll    End of October
to be a staff Member of a future Foundation Hospital
Senior Clinician and Manager FT Events, a 2 Day and 1 Day event             All CDs, Divisional     September and
                                                                            and Directorate           November
                                                                            Managers
Presentation to Trust Joint Negotiating Consultation Committee and the      All Trade Union          September to
Local Negotiating Committee which have representation from staff side       Representatives           November
and Union members.
Articles and information in the Staff Newsletter - Newsround                All staff can access     September to
                                                                                                      November

Engagement of Minority Groups

The Race Equality Council, Hibiscus Group, NORSACCA, Stoke on Trent Black and Minority Ethnic Steering Group
and the Lesbian, Gay, Bisexual and Transexual Group (LGBT) have all received letters and copies of the
consultation document directly. Meetings were offered to all groups before closure of the consultation. Hibiscus, the
LBGT Chair and the BME Steering Group have taken this up during the consultation period, and there are
established arrangements to continue engagement with these groups.

Engagement of Hospital service users

Posters describing the consultation on proposals, how to access the document and advertising the public events
have been distributed across the Trust main entrance sites, with documents also available in the Outpatient
Department. Three patient support groups have requested copies of the consultation document to share at their
networking meetings, these are;
         Cheadle Breast Cancer support group – 18 people
         The Bottoms Up group – support for those with Bowel Cancer – 30 people
         Strokes are Us – support group – 30 people

Engagement of Councils for Voluntary Services as a target for Hard to Reach Groups

An electronic version of the consultation document and a letter was forward to the local Council for Voluntary
Services (CVS) for onward circulation to their network of c 1300 local organisations/community groups working with
formal and informal community groups. The letter asked community groups/leaders to forward the information about




                                                                                                                    5
the Trust to their network of contacts, potentially people who may not automatically seek out and participate in
consultation.

This approach was derived as one of the best ways of reaching those who do not tend to engage in this type of
consultation process from the work of the three Community Focus Group meetings held earlier in the year.

Each CVS organisation included information about the public consultation in their regular Newsletter to Community
groups, and the Trust were allowed to write an article inserted into the Newcastle CVS monthly newsletter.

Engagement of Primary Care, GP Surgeries, Pharmacies, Optometrists, Dentists.

Personal letters, posters and copies of the consultation document were sent to all local primary care providers,
including those in Alsager and Shrewsbury as requested.

Engagement with Community Group for the over 50s

The Trust worked closely with the Newcastle under Lyme 50+ Group to post 330 copies of the consultation
document out with the September Newsletter, and held two sessions with the Group Members to consider the
proposals in October and November.

    2. Exceptions to the agreed Communications Plan

Two aspects of the original plan agreed by the Board and West Midlands Strategic Health Authority were not
delivered during the consultation period these are described below with the reason for the variation to the plan.

       Distribution of leaflets on the consultation to homes and businesses across the North Staffordshire region by
        including the document as an insert in a local newspaper.
       The Trust appoint a dedicated member of staff based in the outpatient department to raise awareness,
        distribute the summary of the consultation document and to answer questions and queries.

The former was discounted before consultation as the mail drop could only be delivered in the last weeks of the
consultation period, this would have been too late to bring sufficient benefits in extra engagement and responses.

The appointment of a dedicated person in the outpatient department proved difficult to operationalise during the
consultation period as this is only a temporary post. Recruitment has now been completed and a person will
commence in February 2009 to continue to share Trust plans with those attending the department, and to directly
recruit prospective Members throughout 2009.

    3. Board Assurance and decision on Consultation Process

The Board need to be assured that the Consultation process has been delivered as required by the Cabinet Office
Code of Practice on Consultation.

The five criteria applicable are set out below.
   1. Consult widely throughout the process, allowing a minimum of 12 weeks for written consultation at least
        once during the development.
   2. Be clear about what proposals are, who may be affected, what questions are being asked and the timescale
        for responses.
   3. Ensure that consultation is clear, concise and widely accessible.
   4. Give feedback regarding the responses received and how the consultation process influenced the
        proposals.
   5. Monitor the effectiveness of consultation

The Board are asked to determine whether the process described above, meets the first three of these criteria and
to seek assurance that criteria 4 and 5 will be met in a reasonable set time period. The Board are asked to seek
confirmation that a report on effectiveness of consultation is produced to include how appropriate representation of
minority communities of race, gender, disability and mental health can be achieved in the Membership Strategy




                              Outcome of the Consultation

                                                                                                                   6
                                                  Content Page


Written Responses Received as at 16 December 2008.                                                       8


Table 1. Breakdown of Respondents by postcode, ethnicity, age, gender                                    8
disability, service user in the last 2 years.


Table 2. Consultation responses to specific consultation questions on                                  9 -13
proposed governance and will the plans improve services.


Table 3. Summary of themes received to “What one think would you like                                    14
us to achieve in the first three years as a foundation hospital?”


Table 4. Responses to “Do you think we should consider other aims and                                14 & 15
priorities should the Trust consider at this time”.


Table 5. Summary of additional comments other than in response to                                        15
specific questions.


Staff Membership.                                                                                        15


Summary of the outcome and Recommendations.                                                          15 to 17


Attachments
A. Questions received during North Staffordshire Pensioners Convention                               18 & 19
Meeting; a range of Neighbourhood Forums; 50+ Group
B. Key Stakeholder Feedback                                                                          20 – 22
C. Additional comments received                                                                      23 - 26




                                        Outcome of the Consultation

Written Responses Received

It is disappointing that after a significant engagement programme engaging over 1,800 of the public and all staff, as
at 16 December 2008, the trust had received only 144, written responses to the Consultation, 37 of which were from
staff. It is proposed to continue to collate any further returns received so that the Board can track all comments that
people have returned. NHS Stoke have yet to provide a written response, but they advised the Board was broadly in
favour with the plans to progress to NHS Foundation Trust status during there public Board meeting 27 November.



                                                                                                                      7
Everyone who returned a written response did not answer every question therefore the numbers shown below do
not all add back to 144. Fifteen of the respondents did not include a name and/ or address, these returns have been
included in the analysis that follows.

Additional to the analysis of the written returns, a summary of the questions and comments received during the
formal presentations to groups have been collated for Board Members to consider, these give an additional
indication of the issues that are most pertinent to the public at this time. These are included as attachment A.

Table 1 below shows a breakdown of those who responded and indicated postcode, ethnicity, age, disabled, gender
and service user in the last two years.

CW2 Shavington, Crewe                            1        White British                                    107
CW3 Madeley, Crewe                               1        White Irish                                        2
CW9 Northwich, Crewe                             1        Other White Background                             3
SK12 Poynton, Cheshire                           1        Asian or Asian British Indian                      2
ST1 Birches Head, Hanley                         4        Asian or Asian British Pakistani                   1
ST2 Bentilee, Light Oaks, Abbey Hulton           7        Black or Black British African                     2
ST3 Longton, Blurton, Meir, Weston Coyney       12        Black or Black British Caribbean                   2
ST4 Fenton, Penkhull, Hartshill, Trent Vale     18        Mixed White & Black African                        1
ST5 May Bank, Westlands, Newcastle              25        None Given                                        24
ST6 Smallthorne, Sneyd Green, Chell,            15
Tunstall
ST7 Kidsgrove, Butt Lane, Talke                 10        Age group
ST8 Gillow Heath, Biddulph                       5        0-16                                               1
ST9 Werrington, Endon                            5        17-25                                              9
ST10 Cheadle                                     2        26-50                                             41
ST11 Forsbrook                                   1        51-65                                             33
ST12 Tittensor                                   2        66-80                                             21
ST13 Leek                                        6        81 & over                                          2
ST15 Stone                                       2
ST16 Stafford                                    3        Gender
ST17 Stafford                                    1        Male                                              61
ST18 Stafford                                    1        Female                                            69
ST21 Eccleshall                                  1
SY3 Shrewsbury                                   1        Do you consider yourself disabled? (120           18
                                                          responses)
TF9 Ashley, Market Drayton                       3        Have you used the service in the last 2           66
                                                          years? (106 responses)
B16 Edgbaston                                    1

The returns show that compared to the profile of the local population, there was an adequate representation in
respect of ethnicity, gender and age groups with the exception of those under 14. Only 18 respondents stated they
considered themselves disabled, this appears under representative of our population.

Table 2 below sets out the questions asked, the total number of respondents who answered this question and the
percentage of respondents who agreed with the question, indicated by Yes, and the percentage of respondents who
disagreed with the question, indicated by No. Any additional comments respondents included on their returns are
documented in the columns to the right.




                                                                                                                    8
Table 2
 Consultation Questions       Total    Yes   No     Comments where respondents disagreed                         Comments where respondents agreed with
                           responses    %    %               with the proposal                                               the proposal
Do you agree with our          118     89    11   12 year old members? – meaningless.                           Give parents more opportunity to be involved in decisions.
proposals for the public                          I agree with the bulk of this but do we need a specific       I do, although as technically I am someone living in "the
constituency?                                     group for under 16's as their point of view and               Rest of England" but working very closely to the hospital
                                                  expectations are very different from those of the             I do feel it's a shame some other boundaries could not be
                                                  adults.                                                       devised- but do understand the meaning.
                                                  Are you sure that your "Rest of England" constituency         Somewhat higher committee strength than I would
                                                  meets monitor's criteria? What about Wales?                   expect.
                                                  Too many non elected members on membership council            Working together can move mountains.
                                                  It ignores frequency of use and is probably based on the      It is important to have a variety of views.
                                                  numbers in an area.                                           It appears to represent the areas which are affected.
                                                  Why are over 11s included? They do not contribute so          Accountability and consultation are key elements in the
                                                  why should they have an input?                                perception of public institutions. There must be safe
                                                  The age profile should reflect our patient demographic.       goals to ensure such arrangements are not 'Hijacked' by
                                                  It is clearly ridiculous to have a large representation of    pressure groups.
                                                  11 year olds.                                                 It is important that the people using the service have an
                                                  Provision should be made to include Governors from            input providing that it is constructive and not critical.
                                                  Stafford specifically rather than include in the rest of      Just will do.
                                                  England.                                                      Would two members adequately represent the whole
                                                  We don’t disagree with the global structure. Our concern      "Rest of England" and what about the representation of
                                                  is with the mechanism for electing people on the              users of Paediatric Specialists from Scotland, Wales etc.
                                                  Membership Council. Cinderella services (learning             Account ability is about institutional culture- do not fear
                                                  disabilities, dementia, mental health, cultural groups        communication- and remember the public is larger then
                                                  etc.) rarely have a voice in the public services and their    the patient constituency.
                                                  voice can be understated. How are these groups to be          Good idea
                                                  properly represented.                                         If given good induction/training
                                                  The claims that foundation trusts offer more democracy        Public should take ownership as the hospital is theirs.
                                                  than the current system are false. Members have little        I think that advertising membership internally and across
                                                  or no influence beyond their vote. UHNS has been              the catchment areas will be vital to ensure a vibrant
                                                  involving the public in designing and planning services for   strong Trust.
                                                  at least the decade since Fit Fir the Future work started     And to consider a pre-determined element of the group
                                                  in earnest.                                                   to be experienced service users.
                                                  Change the minimum age to 18 for Members and                  The involvement of the public is a positive development
                                                  Governors, there are many ways of involving teenagers in      and again can help to build confidence.
                                                  the design of their care but it does not need to go with      Young peoples rights to be members and have a say needs
                                                  voting rights. Ordinary members of the public involved in     to be listened to.
                                                  Local Involvement Network activities could easily achieve     Close involvement for public members would keep their
                                                  as much or more than the average member. You talk of          interest for a longer period.
                                                  some 16,000 public members as a minimum in your
                                                  defined constituencies but that is a tiny proportion of
                                                  the electorate and even if the turnout in elections is
                                                  some 30% governors will still be elected by a handful of
                                                  people. That's not an increase in accountability.




                                                                                                                                                                         9
Consultation Questions       Total    Yes   No     Comments where respondents disagreed                        Comments where respondents agreed with
                          responses    %    %               with the proposal                                              the proposal
Do you agree with our        117      90    10   Staff should be paid more.                                   People working at the 'chalk face' and their 'managers'
proposals for the staff                          Only 1 medical and Dental member? Has everyone               can inject a realistic view.
constituency?                                    forgotten that patients attend hospital to receive care      How will it affect staff that opt out?
                                                 from Doctors. primarily (and no, I do not undervalue the     If it is based on employee numbers- not top heavy with
                                                 care given by other staff).                                  management.
                                                 Your staff should be paid more.                              On the presumption that it is looked at employee
                                                 Building a staff membership with a "Counting Out"            numbers.
                                                 assumption would send a powerful signal. "Counting In" all   Staff involvement is crucial, and that this is a mechanism
                                                 staff is pointless particularly if only a small proportion   for dialogue from the top to the bottom of the
                                                 becomes involved and votes.                                  organisation- something that is poorly lacking at the
                                                 More medical membership is essential with more               moment.
                                                 governors.                                                   The Trust needs staff (and volunteer) support.
                                                 Medical and Dental 2, Administration 1, All Scientific etc   This method means staff members must act in order
                                                 2.                                                           NOT to be members of the foundation.
                                                 Perhaps we need representation from the support              Grass root and public face staff to see how services are
                                                 services.                                                    delivered and how service users react.
                                                 Too many /disproportionate managers and nurses. Little       The staff need to be motivated and feel valued and
                                                 regard for clinical expertise. "1 doctor/dentist of 38       having a staff constituency could have positive effects on
                                                 members! We could have 20, 11 year olds! And 1 clinical      staff moral.
                                                 expert.                                                      But need to include teachers and outside visiting
                                                 We welcome the staff constituency. Staff should have a       professionals i.e. social workers, respite carers, etc.
                                                 strong voice within the design of services. We have been     Good idea.
                                                 advocating for some years that there should be staff         I think every staff should be a member so as to see this
                                                 observers on the Trust board. With the guardianship          foundation trust live up to expectations.
                                                 role, this could be too narrow; it should not be just on     It is important to have the views of the people doing the
                                                 behalf of the trust but also on behalf of the local          job- too many decisions are made by officials who have no
                                                 community. It must be parochial. It has to take due          concept of the "ground level" issues.
                                                 regard of other health provision not provided by the         All staff have their roles and parts to play- their
                                                 foundation trust, and it has to take due regard to how       involvement and involvement as members establishes a
                                                 the NHS works nationally.                                    common and shared value.
                                                 Each department should have a Chairperson, co-chairman       If given training and replacement hours at their place of
                                                 and monthly staff meetings outside normal working            work. (i.e. cover for absence).
                                                 hours. Approx. 2 hours.                                      Working staff have a great commitment to the running of
                                                                                                              the Trust.
                                                                                                              I would be interested to understand the weightings
                                                                                                              applied to determine the number of staff
                                                                                                              representatives; it seems as though "Medical and Dental"
                                                                                                              staff are underrepresented with only one staff Governor.
                                                                                                              In principle but would need to know make up of council
                                                                                                              before commenting. Private contractors with vested
                                                                                                              interest must be excluded. As long as staff are not made
                                                                                                              to feel out of place if they chose not to become a
                                                                                                              member.




                                                                                                                                                                    10
Consultation Questions           Total    Yes   No     Comments where respondents disagreed                        Comments where respondents agreed with
                              responses    %    %               with the proposal                                              the proposal
Do you think our plans will      112      90    10   Free Parking…SOT is one of the poorest areas in UK. The      With greater local involvement and ability to meet locally
help to improve services                             residents of North Staffs will appreciate if they could      the Trust must be able to improve services for local
for local people?                                    keep a few more pounds…etc                                   people. ; Possibly- only if they are accessible to local
                                                     Not if P.C.T cannot get it's act together. It will look as   people and what is commissioned is correct.
                                                     if the patients are being dropped by the hospital.           Particular attention need to be paid to patient pathways
                                                     Hopefully they will maintain them in the face of a smaller   with health partners for patients discharged from
                                                     hospital but this is by no means certain.                    hospital.; I hope so.
                                                     One main thing to address is the disgusting food and         If the above two goals are achieved.; Definitely.
                                                     supply. It cannot be economical to bring from Wales and      Hopefully it will lead to more awareness of services and
                                                     people do not get correct food.                              job prospects.
                                                     While reduction in HAI's, meeting meaningless targets        Need to encourage feedback from local people using the
                                                     and treating patients with privacy and dignity (this is      service. ; Every little bit helps to improve services.;
                                                     inherent in any form of professional care) these are         Providing you fully interact with the community and the
                                                     meaningless unless there are enough beds to provide          various official bodies.
                                                     care.                                                        Focusing on best use of finances and consulting with
                                                     Look at other foundation hospitals. They are failing,        service uses and staff must surely achieve this objective.
                                                     Bradford and Grimsby are only two. Basics- no staff = No     Yes, but management has to improve its desire to engage
                                                     patient care. The money will be spent on high tech staff     with clinicians.
                                                     not on the people.                                           If plans are carried out it can only mean an improvement
                                                     Its all very well making these plans but you need vision     in services for local people - on the whole I think that
                                                     within the staff to get it moving, how do you intend to      UHNS does a good job compared with other hospitals in
                                                     motivate the key team players.                               the area.; As long as there is no political in-fighting from
                                                     I don't believe foundation trust status will improve         elected members. ; Foundation status is not a 'golden
                                                     services, it was a political move that had no merit in       bullet'. It should polish a framework for local
                                                     2003 and certainly offers no benefits now. Please, just      management to develop appropriate services.
                                                     keep concentrating on the STEPSS, don't be distracted.       Hope so.; Yes- and one way to ensure planning remains
                                                                                                                  flexible to need and developments is to have mechanisms
                                                                                                                  to improve a talk with local people.
                                                                                                                  Yes- Foundation status will help us to invent more on our
                                                                                                                  services. ; But only if the current and relatively new
                                                                                                                  intelligence and skills are maintained. There is desperate
                                                                                                                  need for the retention of a corporate memory- at
                                                                                                                  executive level.
                                                                                                                  Need to take notice of the services that local people
                                                                                                                  want. ;
                                                                                                                  Providing the organisation can deliver.;
                                                                                                                  I believe that as soon as we begin to meet the 18 week
                                                                                                                  targets the public will have more trust in us as an
                                                                                                                  organisation. ; The outworking and reality of the plans
                                                                                                                  will. Communication with patients is vital- if they are kept
                                                                                                                  "in touch" they will feel more confident in their care.
                                                                                                                  It will definitely help considering the aims and
                                                                                                                  objectives.; If you meet your aims and objectives.




                                                                                                                                                                          11
Consultation Questions        Total    Yes   No     Comments where respondents disagreed                         Comments where respondents agreed with
                           responses    %    %               with the proposal                                               the proposal
Do you agree with our         112      93    7    Feel that elected public should represent larger              Try the new proposals- and then change the methods if
proposals for the public                          percentage in governance.                                     not working.
Governors?                                        As the chairman pointed out clearly on 27th November          Try it and see how it works.
                                                  they have no special power or influence.                      Providing it is representative of the constituency
                                                  Does not state how long governors are expected to             members in proportion.
                                                  serve.                                                        If the Board and Public Governors are appropriately
                                                  Not if they have a vested interest. All governors should      composed, it will offer a useful forum. However I would
                                                  vote in post.                                                 hope that Governors would have a wide view of the health
                                                  The Trust board will have 24 members with no clinical         economy.
                                                  expertise. This is unworkable pandering to "P.C." wishes.     If expenses only are paid.
                                                  How does your draft constitution deal with instances of       As long as they are not politically motivated.
                                                  Governors firing the Chairman and or NEDs?.                   'Maybe under 16 representation?'
                                                  Who appoints the NEDs do the Governors simply confirm         Should support services have a governor? This is a large
                                                  the Board’s choice? This is a critical issue and need         area of the trust now.
                                                  clarifying. Exactly what powers do you intend Governors       The whole project appears to have been very thoroughly
                                                  to have?                                                      researched and therefore seems acceptable.
                                                  Don’t think the Governors are a broad enough spectrum.        Yes, but some thought to losing one of these posts in
                                                                                                                order to provide an extra staff governor would be
                                                                                                                welcome, or are they fixed by central government?
Do you agree with our         114      89    11   Like it or not the Trust has to take advice from clinical     May need more staff governors as these are the people
proposals for the staff                           experts. The council does not reflect this, and will not be   providing the proposed services.
Governors?                                        clinically accountable.                                       Extremely important to include and empower staff
                                                  How long are they expected to serve.                          without them change will not happen.
                                                  Why are there more governors in Stoke, 9 compared to          They are key to bridging the gap which corrects the
                                                  Newcastle 5 Staffs Moorlands 4. Why not equal numbers         Trust beliefs in staff and management. Again the Staff
                                                  when it comes to decisions.                                   Governors need a broad view and not confine themselves
                                                  Only one doctor but three nurses?.                            to narrow sections of staff with particular interests.
                                                  Scientific , therapeutic and technical staff                  It is important that staff governors are taken from the
                                                  representation.                                               whole service.
                                                  I would like to see staff governors now and people in         It is important to have an input from staff who see all
                                                  control who are dedicated to the service and community        aspects of such an organisation.
                                                  of the service as national and not as a "profit making"       Can we know the breakdown of the various staff groups
                                                  venture.                                                      so that we can see the basis of the Governors to staff. I
                                                  Unless there is greater medical representation on both        believe senior medical staff lead the delivery of
                                                  the Trust Board and Membership Council you risk               healthcare and need more representation on the council.
                                                  alienation of medical staff.                                  If we expect to make a real difference in patient
                                                  Doctors/Consultants should be accountable to the              experience there has to be greater involvement of senior
                                                  Membership Council, and should be able to inform the          doctors.
                                                  council as exoert practitioners. Their lack of
                                                  representation precludes this.




                                                                                                                                                                     12
Consultation Questions       Total    Yes   No     Comments where respondents disagreed                      Comments where respondents agreed with
                          responses    %    %               with the proposal                                            the proposal
Do you agree with the         110     88    12   Should include representatives from GP's/Primary Care      See what the demand is and keep under review.
proposals for appointed                          appointment must be minimal. Non elected cannot claim      A&E governors should be elected.
Governors                                        to represent anyone but themselves.                        Selection of appointed Governors will have a key impact
                                                 All governors should be voted in post. Not if they have    on the success of this whole process. Appointed
                                                 conflicting interests.                                     Governors should be willing to take on the considerable
                                                 Do they serve forever?                                     commitment placed upon them.
                                                 Wrong balance.                                             As long as they are not politically motivated
                                                 Staffs L.A. Representation must be North Staffs.           Yes if expenses only are paid.
                                                 Newcastle/Moorlands Borough/District to nominate.          As long as they are not politically motivated
                                                 University why Staffs? Keele has greater relevance.        On the whole
                                                 Some FTs have governors from their local involvement       Will help with engagement of partner organisations
                                                 networks. Consider this.                                   hopefully.
                                                 The Chair should be a non executive director not the       Appears fair
                                                 Trust Board Chair.
                                                 The Chair should be a NED from the Trust Board other
                                                 than the Trust Board Chairman.
                                                 Following discussions with Staffordshire County Council
                                                 and Newcastle Borough Council, the Chairman of the
                                                 Health Scrutiny Panel would propose the Staffordshire
                                                 County Council, Staffordshire Moorlands District Council
                                                 and Newcastle Borough Council…
                                                 We are concerned that only two local authority
                                                 Governors are proposed from the City of Stoke-On-
                                                 Trent and Staffordshire County Council. We should
                                                 welcome an extension to include representatives from
                                                 the more locally focused Borough Council here…………
                                                 The number of governors for CVS should be increased to
                                                 3 to represent S-O-T, Newcastle and Staff Moorlands.




                                                                                                                                                                 13
The Consultation document also asked “What one thing would you like us to achieve in our first three years as a
foundation hospital?” .The responses have been collated into themes a summary of the number of responses under
each is shown in Table 3 below.

Table 3
Themed Area of Response                                                                                      Number of responses
clean safe environment                                                                                               22
reduce waiting times (includes comments on Emergency Department)                                                     19
excellent health care                                                                                                14
financial stability                                                                                                  12
adequate staff levels                                                                                                 5
increase efficiency                                                                                                  15
free/better parking                                                                                                   6
better communication                                                                                                  7
local services driven by local needs                                                                                  5
career development/stability                                                                                          4
better food                                                                                                           3
basics/foundation right                                                                                               4
against FT proposal                                                                                                   1
Other                                                                                                                 5
Totals                                                                                                              122

The Trust received 110 comments on the question of considering other aims and priorities at this time, forty five
percent of those who responded stated that the Trust should consider others, but as can be seen for these shown
below, many relate to immediate rather than strategic. Table 4 below shows the responses and details what people
captured as other priorities the Trust should consider.

Table 4
 Consultation          Total    Yes   No           Comments where respondents thought UHNS should consider other priorities
   Questions        responses    %    %
Do you think we         110     45    65    Notes being available in clinics well before patient arrives so they don’t wait for hours for them to
should consider                             arrive. The notes will have necessary paperwork.
any other aims                              Improve the quality of care provided to patients.
and priorities at                           One should always keep an open mind. Aims and priorities can change overnight.
this time other                             Enhancing provision of services for patients so that they can understand how to access them and
then those in                               do so in a timely manner.
our vision and                              Become a good employer and develop staff and skills to deliver healthcare.
strategic                                   we should consider all aims and priorities and make sure the hospital is germ free like France and
objectives?                                 Holland.
                                            Make yourselves known by getting out and meeting staff more often.
                                            Improve communication between primary and secondary care. Simplify referral system and
                                            improve computer links.
                                            Improve hospital food. It is appalling.
                                            Increase levels of staff on wards.
                                            Everything should be considered
                                            Staff retention levels to increase through permanent contracts and redundancies.
                                            Actually ensure that patients/residents do take part in meaningful consultations.
                                            Keeping specialist surgeons that have been trained by the trust.
                                            Appropriate referral to other agencies by explaining systems more fully to patients/ carers e.g.
                                            elderly/mental health.
                                            To have more dialogues between managers and clinicians. It is difficult to get help of a manager
                                            than a consultant.
                                            Promote the recruitment and training of nursing at all levels and in specialities too that fit with the
                                            hospitals expertise and services.
                                            Convince people that it is not the fragmentation and break up of the health service
                                            Focus on ensuring inclusion of minority groups i.e. different faith/beliefs; race/culture; sexuality;
                                            age.
                                            You have briefly touched on the skills academy, I believe we should aim to be an employer of
                                            choice in the area so that the most skilled workers want to be a part of the organisation.
                                            To develop a carefully monitored system which gives a TRUE picture that a caring ambiance has
                                            been achieved.
                                            Deep cleaning as a must. Good nursing at basic level. i.e. feeding elderly, helping sick patients
                                            washing etc. Nurses often think basic care is below them as they have degrees. Teaching needs
                                            to be more in house.
                                            Do more fundraising - get them to pay for tea.
                                            Parking made free and adequate for all staff and patients.
                                            Encourage and support all staff through training and educational opportunities to improve their
                                            position in the Trust.




                                                                                                                                             14
                                       Combined speciality services for children and adults with co-ordinated orthopaedic, neurosurgery,
                                       rehabilitation and orthotics services. Visitors needs!
                                       To give greater priority in considering service- user views and acting on them or explaining why
                                       this is not possible.
                                       Reduce cancelled operations remove the queue for blood pressure.
                                       Safer and improved parking for relatives, patients and staff.
                                       Bed management.
                                       Waiting times. Development of nurse training 'basic care' often lost due to written assignments.
                                       More bedside training.
                                       An improvement of the overall health of the community.
                                       Employing more staff across the board from domestics- Doctors, better staffing numbers
                                       especially on nights.
                                       The 'Vision and Strategic Objectives' are those we would expect you already have within the
                                       UHNS. How the Foundation Trust would enhance the present vision and strategies is not clear.
                                       The process of improvement should continue.
                                       Help those with mental health? Left out since St. Edwards Hospital closed.
                                       More beds so that patients can be treated with dignity and privacy instead of on a trolley in the
                                       middle of a ward, on a chair because another patient is in the bed in that space, or on a corridor as
                                       I have seen frequently over the last 2-3 months.
                                       I do think that staff training, including shadowing, would go a very long way to achieving very high
                                       levels of clinical effectiveness in the trust.
                                       Psychiatrists taking you seriously so that you get admitted to Harplands before the crisis builds up
                                       to seriousness. Faster access to psychiatrist in A & E, like when the police or ambulance involved.
                                       To ensure a high priority of specialist care with regard to stroke patients.
                                       The aims are laudable but have no creditability without a commitment to appropriate staffing
                                       levels.
                                       It was hard trying to get baby to sleep with TV on and chatting and visitors.
                                       The present so called "credit crunch" is a prime example of private sector involvement in society.
                                       When it all goes wrong the tax payer is doubly charged the "private sector would bring in the
                                       bailiffs.
                                       An objective worded around the need to leave behind older or bad practices (which arise from use
                                       of old premises) as moves into new premises take effect. ("fresh start").
                                       We endorse the aims and priorities that the University Hospital has identified at this time and we
                                       are confident that the Trust will continue to engage with all interested parties in identifying further
                                       priorities at the appropriate time.

We also received a range of additional comments which could not be associated with questions, a list of the themes
of this is shown in Table 5 below, and a full list is shown at attachment C.

Table 5
Theme of Additional Comments                                               Number of responses
Improve communication                                                              10
Improve waiting times                                                               2
Improve standards                                                                  12
Governors/representation                                                            7
Finance                                                                             5
Premises                                                                            4
Staffing/HR                                                                         9
Governance                                                                          8
Respond to local needs                                                              3
Catering                                                                            1
Other                                                                               9
Comments on consultation                                                            3
Total                                                                              73

Staff Membership

The Board proposed that all staff should become Members of a future NHS Foundation Trust unless they chose to
opt out of Membership. As of the 16 December 71 staff out of around 7,400 have asked to opt out of being a
Member. This equates to less than 1% of staff employed at the Trust.

Summary

In summary the Board are advised that overall the response may be considered as supportive of the proposals to
move to NHS Foundation Trust status with the need for some immediate action and some amendments and
assurances around the governance of such a Trust.



                                                                                                                                       15
The richness of the accompanying comments received both written and as questions during the public and staff
sessions, give the Trust a good measure of what the public and staff feel is critical for the Trust to achieve in the
immediate term particularly service performance, and over the next few years.

In order to build confidence, it is clear that the public will need ongoing assurance in three key areas.

       service quality and performance
       adequate local accountability and controls in place to ensure no future fragmentation of care services
       that decision making and performance reporting are open, subject to challenge and are transparent.

Ongoing demonstration of how the Trust are achieving on these matters in the preparation for, and achievement of
NHS Foundation Trust status will be critical to embed the new culture as a public benefit corporation accountable to
Members and Governors.

The Board are asked to consider the following matters and proposed recommendations.

        Challenge – Evidencing accountability and controls to local people. Respondents expressed a range of
        concerns that in achieving NHS Foundation Trust status, the Hospital would be less accountable than at
        present.

            A specific issue was raised asking the Board to consider holding Board meetings in public once
            Foundation status is achieved. This matter was raised by a local MP, the North Staffordshire Pensioners
            Convention, the Newcastle under Lyme 50+ group and the Overview and Scrutiny Committees at
            Stafford Borough Council and Stoke on Trent City Council.

            Recommendation

            To change the draft Constitution to show that additional to all of the Membership Council meetings being
            held in public, there will be quarterly Trust Board meetings held in public. This frequency matches the
            quarterly reporting requirements a future NHS Foundation Trust would be working too.

            Recommendation

            In order to build public confidence further, that during 2009 the Trust continue to attend the public fora
            identified and utilised during the consultation period specifically to;

                    Feedback directly to these groups on the outcome of the public consultation and changes.
                    Provide a direct means of updating the public on the Trust plans moving forward and managing
                     questions and concerns relating to the Trust reputation including any issues and media stories.

                 The Trust continue to develop methods of engaging with all minority groups and build the
                 relationship to ensure adequate engagement into a future Membership Strategy. This action will
                 help the Trust in managing the reputation and public confidence, provide evidence of engagement
                 and help to grow accountability that will support Membership and Governor recruitment, and have
                 mechanisms both can use once authorised as an NHS Foundation Trust.

                 The Trust develop a method of evaluating and reporting the impact of a future NHS Foundation
                 Trust.

        Challenge to the single Appointed Governor representing Staffordshire Councils, these include Stafford
        Borough Council, Staffordshire Moorlands District Council and Newcastle under Lyme Borough Council.

                 A question has been raised as to how a future NHS Foundation Trust ensures appropriate
                 representation of Staffordshire Local Authority services. The Trust proposed one Governor for this
                 area, the respondents have challenged this and asked for a representative for the three areas,
                 Stafford Borough Council, Staffordshire Moorlands District Council and Newcastle under Lyme
                 Borough Council.

                 Recommendation



                                                                                                                        16
      The Trust cannot offer three Appointed Governor seats to the three Councils without increasing the
      public Governors as this would not meet the legal requirements for the Constitution to always have a
      majority of public Governors . Therefore it is recommended that the Trust meet with the three
      Councils and agree appropriate adequate Appointed Governor representation, specifically to ensure
      adequate Social Service engagement in a future Membership Council.

Challenge to the number of Staff Governors representing Medical and Dental Staff

      A couple of respondents have suggested there should be more than one Governor for Medical and
      Dental Staff.

      Recommendation

      The Trust do not change their rationale of having one staff Governor for around every 700 staff,
      this equates to one for Medical and Dental staff.

 To consider further changes to be incorporated into the updated Trust Five Year Plan

    Recommendation 5

   To consider further changes to be incorporated into the Trust Five Year Plan to include
   comments that respondents suggested as additional aims, priorities and achievements in the
   first three years as an NHS Foundation Trust. To report this to the Board on production of the
   updated Plan.




                                                                                                         17
                                                                                                                                         Attachment A

                                            North Staffordshire Pensioner Convention Meeting
How do we guard against privatisation? In 1981 colleague at St Helier Trust in London, sent a letter to the Times        Questioner 1
about the cleaning services being privatised and concerns they would never be the same again. We are becoming
more like the American system where thousands of people do not get health care.
Why have we privatised hospital food so that we are now transporting food from Wales?                                    Questioner 1
I was in hospital earlier this year and the food was fine, its now crap. Why have we broken a perfectly good system?     Questioner 2
Why are we not using local firms?                                                                                        Questioner 2
Food is our medicine, if we eat well we keep well. Where is food as a priority for the NHS? It is essential to prepare   Questioner 3
food close to the patient, and you are building a brand new hospital why haven’t you allowed for food preparation
areas?
I haven’t heard in any of the presentation the patient mentioned once, and what are the benefits of foundation           Questioner 4
status?
Why change a system that isn’t broken we do not need foundation status to get people involved.                           Questioner 4
How will the voting system work?                                                                                         Questioner 4
It sounds to me like we are heading for privatisation, like the American and European systems, particularly Germany!     Commentator
I lost my Wife earlier this year, she had a terrible time, she waited on a chair in A&E was moved the AAU after 8        Commentator
hours, was put on a hard bed, I asked for a softer one but they said they didn’t have one. Then was transferred to
Ward 80.
What training and information is there going to be for Governors to ensure they represent people.                        Questioner 5
How can this be democratic when the real decision has already been made?                                                 Questioner 6
Hospitals in London are going bankrupt. With our PFI can you guarantee that patients in 30 years time can afford         Questioner 7
the hospital and it won’t affect the services they get?
What is the mortgage payment a year?                                                                                     Questioner 7
The consultation is a sham it’s a done deal!                                                                             Commentator
Why should we follow and be the same as everyone else, we do not need foundation status!                                 Commentator 8
                                                  Newcastle under Lyme 50+ Group Meeting
Finance – will we need/intend to cut services to pay for the PFI?                                                        Questioner 1
What is the criteria for being a Governor?                                                                               Questioner 1
Will the hospital accept what is said at Board?                                                                          Questioner 2
Meetings by Governors – what is the power?                                                                               Questioner 3
Number of beds?                                                                                                          Questioner 2
Is this 1st step to privatisation?                                                                                       Questioner 4
Will transmission for patients be smoother?                                                                              Questioner 5
Skills for Governors and any payment?                                                                                    Questioner 6



                                                                                                                                                  18
Public Governors – same status?                                                                                Questioner 7
Why are Volunteers in a staff group, should they not have a Governor all of their own?                         Questioner 8
How can you make sure it isn’t privatisation?                                                                  Questioner 9
Difference?                                                                                                    Questioner 10
Membership?                                                                                                    Questioner 11
Privatisation?                                                                                                 Questioner 12
Can an FT choose the services and drop them if they do not make money?                                         Questioner 13
Why are Volunteers included with a staff group, they should have their own Governor?                           Questioner 14
Why are you suggesting Members from age 11?                                                                    Questioner 15
                                                            Neighbourhood Groups
How many beds and parking spaces are there in the new hospital?                                                Questioner 1
Are the hospital planning to offer reattachment of retina, I had to travel to Manchester?                      Questioner 2
Why don’t Doctors wear white coats anymore?                                                                    Questioner 3
When will you need the Governors?                                                                              Questioner 4
What are you doing letting staff in uniforms go shopping, what about the infection risk?                       Questioner 5
Why does Staffordshire Moorlands not have a Governor?                                                          Questioner 6
Why have Doctors stopped wearing white coats?                                                                  Questioner 7
Do the new plans include improving A&E as I was left the queuing in the corridor recently?                     Questioner 8
Why are visitors allowed to lie on beds with their shoes on, my Husband was on a heart ward and we saw this?   Questioner 9
A friend of mine was in your hospital recently and the food was awful - why are you bringing it from Wales?    Questioner 10
Why do you not provide food yourselves surely its cheaper and you will know the quality?                       Questioner 11
How long is the food contract for and why bring it from Wales?                                                 Questioner 12
The carbon footprint transporting the food must be huge and your saying you want to socially responsible?      Questioner 12
What are the consequences of the PFI - how long is the contract for? Who owns the hospital at the end of the   Questioner 13
contract?
Staffordshire Moorlands needs its own representative not just Staffordshire Council.                           Questioner 14
What did the hospital make the savings and what did you cut?                                                   Questioner 15




                                                                                                                               19
                                                                                                                                                                     Attachment B
     Consultation              Stakeholder Organisations                                                             Response
      Questions
What one thing would you      Staffordshire Moorlands District   A hospital that provides excellent standards of care and treatment and works effectively with local PCTs and
like is to achieve in our     Council                            other partners to provide services to patients in local settings to avoid the need to attend UHNS. Services in local
first three years as a                                           settings will provide greater benefits for UHNS and patients, especially those living in rural areas.
foundation hospital?          Newcastle under Lyme Borough       The public rightly expects excellent health care from whichever service provides it. The reputation of UHNS
                              Council                            would be greatly enhanced if it could demonstrate the services it provides are recognised as being excellent by
                                                                 patients, the public and external assessors. This would be a significant achievement and worthy of prioritisation.
Do you think we should        Staffordshire Moorlands District   The aims and priorities identified have been supported by Members. Members feel that communication with local
consider any other aims       Council                            people is key as detailed for the reasons later.
and priorities at this time   Newcastle under Lyme Borough       Endorse the aims and priorities of UHNS as identified at this time and are confident the Trust will continue to
other then those in our       Council                            engage with all interested parties in identifying further priorities at the appropriate time.
vision and strategic
objectives?
Do you think our plans will   Staffordshire Moorlands District   Hope FT status will allow more close communication with local people and provide a better understanding of the
help to improve services      Council                            Trust responsibilities and NHS structure as a whole.
for local people?             Newcastle under Lyme Borough       Believe that Foundation status will better position the Trust to have greater autonomy in its decision making
                              Council                            processes and consequently this localised decision-making particularly with regard to managing budgets, should
                                                                 realise better services for local people.
Do you agree with our         Staffordshire Moorlands District   Members would like to see the age of children’s involvement to be 13 instead of 11.
proposals for the public      Council
constituency?                 Newcastle under Lyme Borough       Fully support the proposals put forward and see them as fair and equitable to the various populations of the local
                              Council                            authority areas serves by UHNS.
Do you agree with our         Staffordshire Moorlands District   Support the proposals.
proposals for the staff       Council
constituency?                 Newcastle under Lyme Borough       Fully support the proposals put forward.
                              Council
Do you have any other         Staffordshire Moorlands District   Recommend that Members are asked to state their preferred means of communication as individual preferences
suggestions on how we         Council                            will vary. Close communication links as have been built with the District Council should continue as this assists with
should communicate with                                          ensuring accurate messages can be passed on to constituents.
Members?                      Newcastle under Lyme Borough       There are a number of avenues open to the Trust to communicate with Members and we would recommended
                              Council                            avoiding the one size fits all approach to communication. Production of targeted information in a variety of formats
                                                                 which is tailored to various audiences is therefore important. Equally important is the need to ensure that there
                                                                 are mechanisms for feeding back promptly the positives that have come about through Members activity and also
                                                                 to highlight good practice.
Do you agree with our         Staffordshire Moorlands District   Following discussions with the County Council, the Chairman suggests reducing the number of Governors proposed
proposals for the public      Council                            to represent the rest Of England by 1 and increasing the number of Governors representing Staffordshire
Governors?                                                       Moorlands by 1.
                              Stafford Borough Council           Reconsider the Rest of England constituency and consolidate with Stafford Borough Councils representation on the
                                                                 Membership Council.
                              Newcastle under Lyme Borough       Fully support.
                              Council
Do you agree with our         Staffordshire Moorlands District   Support the proposals.
proposals for the staff       Council



                                                                                                                                                                                   20
Governors?                    Newcastle under Lyme Borough          Fully support.
                              Council
Do you agree with the         Staffordshire Moorlands District      Following discussions with Staffordshire County Council and Newcastle Borough Council, the Chairman proposes
proposals for appointed       Council                               that Staffordshire County, Newcastle Borough and Staffordshire Moorlands should have one representative each.
Governors                     Newcastle under Lyme Borough          Would welcome an extension to include representatives from Newcastle Borough Council, Staffordshire Moorlands
                              Council                               District Council and Stafford Borough Council.
Other comments received
                              Staffordshire Moorlands District      Support for the proposals.
                              Council
                              Stafford Borough Council              Ask that the new Trust Board meetings be held in public.
                                                                    Support for the proposals overall.
                              Stoke on Trent City Council           Given assurances that the proposal will better involve local people and patients the Committee fully support the
                                                                    application.
                                                                    Committee urge that meetings of the Trust are open to the public unless confidential information is under
                                                                    discussion.
                              Newcastle under Lyme Borough          Unclear how local authority Governors would be appointed.
                              Council

Letters from Staff Organisations
 Consultation Aspects         Staff Representatives                                                                     Response
Strategy                       Royal College of Nursing              Want to see a Strategy for evaluation of achievements of a future Foundation Trust in respect of NHS
                                                                     Principles, including an evaluation of how the Trust has worked in partnership to ensure that the service is based
                                                                     on clinical need and not the ability to pay, ensuring that public funds are directed soley towards NHS patients.
Proposals for                  Royal College of Nursing              One seat on the Governing Council should be for the RCN and one seat on the Governing Council for Nurses.
Membership/constituencies
and Governors
Support for the application    Royal College of Nursing              Notes that NHS Foundation Trusts will be founded upon NHS principles (free care, based on need and not ability
                                                                     to pay).
                                                                     The establishment of NHS Foundation Trusts must not create greater divisions within the NHS (across local
                                                                     health economies) and that their establishment must lead to improved standards of patient care and
                                                                     improvements in service provision across all health care services.
                                                                     The RCN have produced a scorecard reflecting the standards the RCN expects of Trust applying for foundation
                                                                     status to achieve and maintain, they can only support Trust who fulfil this.



Other key Stakeholder Returns
 Consultation Aspects                        Stakeholder                                                                 Response
Strategy                          NHS North Staffordshire               The Board were heartened to hear that UHNS acknowledges that there are clear benefits of alignment of
                                                                        UHNS Strategy with the commissioning strategy of NHS North Staffordshire. Together these plans will
                                                                        ensure that local people will see an improvement in services.
                                  NHS Stoke
                                  Shrewsbury and Telford Hospital       Recognise and support UHNS ambitions to be a fist class provider of clinical services, education, research and
                                                                        development. Key are of partnership is the delivery of effective pathways for the provision of tertiary care.
                                                                        When both Hospitals are NHS Foundation Trusts this will provide opportunities to work with patients and
                                                                        communities to provide care closer to home alongside rapid access to tertiary care when needed.



                                                                                                                                                                                       21
                                  Mid Staffordshire NHS Foundation    The Trust and UHNS have longstanding links involving a wide range of clinical specialities. For some services
                                  Trust                               these links are strategically important to both trusts. We will welcome the opportunity to continue to develop
                                                                      these over time with yourselves once you become a Foundation Trust.

Proposals for                     NHS North Staffordshire             The Trust Board agree with the proposals , encouraged that UHNS is endeavouring to have such a large and
Membership/constituencies and                                         diverse membership and includes many groups. Wish to work together on communication to Members and the
Governors                                                             PCTs local population to avoid confusion.

                                  NHS Stoke

                                  Staffordshire University            Welcome the proposals for a place for Staffordshire University on the Membership Council.
Support for the application       NHS North Staffordshire             In summary the Trust Board of NHS North Staffordshire support the application for Foundation status and
                                                                      look forward to continued involvement.
                                  NHS Stoke                           Support in principle for the application stated at the Public Board meeting 27 November 2008.
                                  Stoke on Trent Children and Young   Wish the Trust well in the application and feel sure that the Trust will continue to respond to the needs of
                                  People’s Services                   Children and Young People whatever their status.
                                  Staffordshire University            Wish UHNS success in achieving Foundation status.
                                  Shrewsbury and Telford Hospital     Look forward to continuing to work with UHNS as a growing NHS Foundation Trust community in the West
                                                                      Midlands, using freedoms to improve quality, outcomes and cost effectiveness of patient services whilst
                                                                      remaining fully part of the NHS.
                                  Mid Staffordshire NHS Foundation    Mid Staffordshire NHS Foundation Trust, wish you, your Board and the rest of the team at UHNS every
                                  Trust                               success in your application to become a Foundation Trust.
General concerns about            North Staffordshire Pensioners      We ask that you show us how the consultation has affected your proposals.
accountability and control once   letter of additional comments       Openness, transparency and accountability, the Board must meet in public.
a foundation trust.                                                   Core services must remain within an future FT and the quality of those services improve, there must be
                                                                      assurances apart from the quality regulator.
                                                                      There are worries that a foundation trust could become susceptible to take over or become predatory in
                                                                      acquisitions of other trusts; and where a trust may diversify into a specialist services though borrowing on the
                                                                      money market, there is a risk that such practice may become detrimental to provision of core services to the
                                                                      local population.




                                                                                                                                                                                   22
                                                                                                                                                        Attachment C

Improve communication      I feel it is very important to keep everyone informed during this process. They are exciting times which will contribute to a positive future
                           not only for staff but patients too.
                           Not all staff use the intranet or would read this booklet, get managers more aware and ensure that staff are made aware via team briefs
                           Greater consultation with people of north staffs.
                           Be visible and approachable and keep us informed.
                           More liaison and referrals with local GP's to University Hospital which seems not existent in local surgery !
                           Much further information and opportunities to question reasoning is needed. Hopefully your arranged public events will prove helpful providing
                           you are willing to listen and act upon public wishes and concerns.
                           Not all staff use the intranet or would read this booklet. Get managers more aware and ensure that staff are made aware via team briefings.
                           From a clinician point of view- we need to cut down red tape and engage in good communication between front line workers in the Trust and
                           managers.
                           I wish to learn more about the hospital, the services it provides and the plans for the future.
                           It is nice to be involved and be part of the FT process implementation.
Improve waiting times      Waiting times could be improved.
                           Hospital waiting time could be improved.
Improve standards          We need to compete with other local hospitals to provide the best possible service.
                           Think it is a good idea, the new hospital, try and find what works and what doesn't work. Keep improving the standards
                           I worked as a nurse in the seventies and it was very strict regime. I know that we don't work to the same standards today but I do think
                           some old values wouldn't go amiss
                           I do wish the hospital well and it should have the face of a hospital with the expertise and facilities of the great London Centres. We are
                           after all in London Road in part.
                           Provide excellent health care without learning from mistakes.
                           Admirable objectives, which will contribute to improving overall health in this region.
                           Just to please bear in mind the requirement in the Darzi report for quality indicators to be used to measure performance from next year,
                           this could be a very good way to improve the trusts standing.
                           Incentive to cut amount of waste on hospital sites. Lost money, manpower and confidence in service.
                           Concerns that Stafford's Foundation Status is struggling
                           You talk of specialised services but make no mention of imaging which is an essential part of patient healthcare. You cannot treat patients
                           unless an accurate diagnosis is made.
                           Patients needing follow up appointments being seen with clinicians have asked to be seen and not waiting 6, 12, 18 months past expected dates.
                           Notes to arrive in clinics well before patient does so they don’t wait for hours for them to arrive. The notes will have necessary paperwork
                           e.g. ID labels, referral letters and continuation sheets already in them.
                           Sufficient car parking for staff and visitors and patients- should be free of charge- when you consider the advanced age of a lot of hospital
                           users.
Governors/representation   The membership council could meet at the Guildhall in Newcastle
                           Each department should have a chairperson, co-chairman and have monthly staff meetings outside normal duty hours. Approx 2 hours per
                           month
                           Ensure that Governors and members remain objective- i.e. don't become committee gurus; focus in a way an organisation needs (NHS) as
                           opposed to community- a balance is needed. Partnership working workforce at ' coalface '- micro level encouraged to be innovative- action not
                           words.
                           A council with 38 members will be very large and unwieldy but do not have an alternative to offer. Will need strong management steer. 2.
                           Concerned that link between council and board not sufficiently robust. Same chair okay but could be compromised? Non-Execs to be found
                           from Governors perhaps?



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              Members should all be appointed for 3 terms and be elected all at once to reduce admin costs of more frequent elections. 1st year formulate
              plans, 2nd year implement improvements, 3rd year refine improvements.
              In formulating these proposals have there been any benchmarking against other NHS Trust governance structures or those of other
              organisations? As the membership Council is only advisory; are there any rights of complaint or escalation if they feel the Board of the Trust
              is failing to fulfil its duties.
              It is important not to undervalue the role of voluntary organisations in your partnership.
Finance       I understand that there will be changes to the way each directorate spends money. If, for example, imaging saves money, will imaging be able
              to spend that money? This will be a great way to get everyone saving money.
              All sounds fantastic and a great way to move things forward and to have accountability. I hope you will have the funds in place to follow it all
              through
              I am in favour of Foundation Trust status providing that the actual nursing and care budget takes priority over administration etc. The issue
              of lack of patient/visitors/staff parking and the cost needs to be considered urgently.
              What will you do if the money runs out? Will you expect the Government to bail you out- I don't want to see the Public Trust Board meetings
              dropped.
              You are correct about the restriction of single - year plans and budgets, but it does not require a complete change in governance to deliver a
              longer planning and financing cycle, the government could simply ask for forward plans and commit funding as required in advance.
Premises      "just" a good looking hospital
              As above to improve our image locally a shelter as used outside pubs etc will help to improve our standing with local residents surrounding the
              hospital.
              We would like to see the demolition of the old parish and Victorian building irrespective of preservation orders. We are in the 21st century,
              our local hospital is moving into the future.
              We would like to see the demolition of the old parish and Victorian building irrespective of preservation orders. We are now in the 21st
              century.
Staffing/HR   We need to change the culture to encourage clinicians to develop new services. It is still very difficult to develop and 'sell' new techniques. It
              always seems to be a battle and often one just gives up!
              Sounds very positive for the recent past.
              Staff grading = staff are leaving due to the poor pay, due to inadequate grading for the responsibility. I have seen foundation trusts re-band
              nurses to lower grades to save money!! Training and education- all staff should be entitled to 3 paid study days per year- improving knowledge
              therefore patient care.
               It is important not to undervalue the role of voluntary organisations in your partnership hence my comment at Q9.
              The staff on the wards holds the key to how to manage this organisation, 6 out of 9 staff are looking for jobs in my area, this speaks volumes.
              A & E staff stop being abusive to people who have had overdosing, psychiatric hospitals send people home to quickly. No change of treatment
              without discussion with patient.
              More face to face meetings in departments by management staff on regular basis promote “team attitude.”
              All bonuses should be equally distributed between all staff grades- shop floor staff working hard and longer hours are the people who really
              help the trust achieve their targets and they should be shown they are appreciated.
              Initiative lists- clinics and theatre, - all staff involved to share in pay incentives not just medical staff but nursing, clinical should be properly
              rewarded for helping trust hit targets.
Governance    Clear governance requires clear focus and a 10 year maximum service be proposed, with a minimum of 3 years.
              I am most concerned that the documents relating to the application by the University Hospital of North Staffordshire for the foundation
              trust status do not make clear whether the Board of the new Foundation Trust will be held in public.
              I had the opportunity recently in Health Select Committee to raise the issue of Foundation trust boards meeting in private with professor
              Sir Bruce Keogh, NHS Medical Director. He confirmed that confidential items on the agenda are kept to a minimum.
              Could you please clarify what the intentions are in respect of the University Hospital of North Staffordshire? Are you proposing that the
              board meet in public? I do not consider that public meetings of Foundation Trust members are in any way a substitute for the scrutiny




                                                                                                                                                                24
                         involved in holding the main Board meetings in public.
                         I would be grateful for an early response to my enquiry as I believe that this issue is central to the case for whether Foundation Trust status
                         for the University Hospital of North Staffordshire should be supported or not.
                          Remain as you are.
                         The way to get increased accountability is to take board meetings and other events out to the public, involve them; you don't need foundation
                         trust status to do it. You said again yesterday that "we're not terribly good at it (community involvement)"! PPI Forum plans for jointly
                         organised community events were rejected out of hand by the hospital yet how ironic that your series of 'drop-in' events and meetings
                         before you have foundation trust status indicates that you really are good at it. Just carry on and do more, then you wouldn't need
                         foundation trust status.
                         It was a major error not to publish your draft constitution in advance of the consultation period.
                         I believe open board meetings are a vital element of local accountability and they are a cornerstone of the current system. No need to
                         change to foundation trust status for that then. The question remains as to how some foundation trusts can 'get away with' holding their
                         board meetings in private; the situation seems unclear and I welcome pursuit of a definitive answer from whomsoever is the correct
                         authority.
                         Naturally foundation trusts will need and want the support of members of parliament and will meet with them whenever necessary. The fact
                         remains, however, that with the arrival of foundation trust status MPs lost their right to get answers from ministers about foundation trust
                         hospitals. Vid. Hansard 8 Dec 2004: Column 1250 Para 5 Parliamentary Under - Secretary of State for Health (Dr. Stephen Ladyman).
                         "Ministers are no longer in a position to comment on or become involved in their (foundation trusts') day - to - day activities. We also have no
                         powers of direction or intervention over those trusts." Similarly at Hansard 11 October 2004 House of Lords Column WS4 the Noble Lord
                         Warner. Very clear. This was a serious loss of local accountability and should not be visited on the people of North Staffordshire.
                         Assure people that forming a Trust is not leading to privatisation.
Respond to local needs   Hope successful application. Hospital needs to be able to respond to local needs.
                         The vision is good- bringing the service to the local people. Hope that it might be achieved.
                         I wonder how "choose & book" will work with only one hospital in the foundation; can people be referred to other hospitals out of the area, If
                         the UHNS goes to foundation?
Catering                 A strong hope that the current problems with catering services can be improved very soon.

Other                    I would be interested in this as a long term patient and/or a member of one of your partner organisations (SBC)
                         All the services I have used have been up to standard but this improvement should be good.
                         Once again I would like to thank you for inviting us to contribute to your consultation on Foundation trust status. We wish you the very best
                         of luck and assure you of out continuing support.
                         You have failed to make any case at all for applying for foundation trust status. It is impossible to do so as the idea came from an era of
                         'New Labour' policy - making when 'business' was viewed as the answer to everything. No - one now believes that. "A foundation trust is not a
                         hospital it's a healthcare business", Clive Wilkinson, Chairman, Heart of England NHS Foundation Trust. This couldn't be clearer; this was the
                         government's intention. This should not happen to our hospital. Foundation trusts were intentionally given a power to form and invest in
                         bodies corporate, this is a pathway to privatisation. I fully accept the assurances which you give that you would not do this. However you can
                         give no guarantees beyond the term of your office. You will be aware that the Moorfields Eye Hospital has set up a private hospital in Dubai.
                         What could be a clearer example of what is possible?
                         Several reports have failed to identify clear and significant benefits of foundation trust status; the sixth report of session 2007 - 2008 of
                         the House of Commons Health Committee was among these and their conclusions and recommendations make interesting reading.
                         The difficulties of establishing a true 'partnership' style of working across the health economy are well known; your deciding to launch your
                         hospital into a new phase of operating community hospitals will alarm many people, no matter how worthy your intentions. This is a freedom
                         foundation trust status should not give you.
                         Ordinary members of the public involved in Local Involvement Network activities could easily achieve as much or more than the average
                         member.




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                               You talk of some 16,000 public members as a minimum in your defined constituencies but that is a tiny proportion of the electorate and even
                               if the turnout in elections is some 30% governors will still be elected by a handful of people. That's not an increase in accountability. The way
                               to get increased accountability is to take board meetings and other events out to the public, involve them; you don't need foundation trust
                               status to do it. You said again yesterday that "we're not terribly good at it (community involvement)"! PPI Forum plans for jointly organised
                               community events were rejected out of hand by the hospital yet how ironic that your series of 'drop-in' events and meetings before you have
                               foundation trust status indicates that you really are good at it. Just carry on and do more, then you wouldn't need foundation trust status.
                               I was very disturbed by your statements on the current and future levels of non-executive pay. Did you really say that the current level was
                               "outrageous"? Did you really say that one of the current non-executives had agreed to take the post but had described the remuneration as
                               "less than I spend on ties"?
                               Were you implying that the pay of the non-executives should be substantially increased if you achieved foundation trust status? Do you not
                               think the non-executives should demonstrate that they deserve any increase on the current level by performance? It seems to me that local
                               people would not look kindly on the non-executives awarding themselves substantial pay increases.
                               I ask you hold a further month's consultation, February 2009, during which you would report back to the whole public, not just those groups
                               you've already met, and would give them the full and true picture of what foundation trust status can and cannot offer. In this period there
                               should be proper public meetings across the health economy area and then a referendum; that would be the democratic way. This application
                               would anyway be a distraction from many more important priorities, running the hospital day-by-day; keeping healthcare acquired infection at
                               the current low levels, solving the long-running A and E and 'delayed discharge problems, fixing the food and PACS difficulties, getting 'zero
                               defects' and 'right first time' into the heart of every part of the organisation, delivering the new maternity and oncology buildings without a
                               hitch, the list goes on!!
Comments on the Consultation   Feedback from Young Peoples group 1) Too many long words 2) Too long 3) Needs to be more colourful (though our copy was a black and white
                               print out) 4) Questions are not appropriate to children and young people-not child friendly. 5) Needs more visual stuff. 6) More Pictures. 7)
Document and Process
                               More informal. 8) Ideally needs to be the size of a CV- Max of three pages.
                               This was not a consultation as I understand the term; it was a networking exercise. Your consultation document was too much like a
                               marketing tool.
                               Complicated and not sure what you aim to do.




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