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Working in Partnership Outcome report of the consultation on our NHS foundation trust application April 2014

Imperial College Healthcare NHS Trust Page | 2 Working in Partnership

//Foreword

In 2013/14, Imperial College Healthcare NHS Trust (‘the Trust’) undertook a formal public consultation programme on its proposals for becoming an NHS foundation trust. We see achieving foundation trust status as a means towards bringing our Trust closer to our patients, the people who work for us, our local communities and partner organisations. This report is an evaluation of the public consultation programme. It describes the consultation processes used, level and quality of responses, and how responses were used to amend the final application for foundation trust status. The Trust would like to thank all the individuals and organisations that participated in the consultation, and provided us with their feedback on our proposals.


//Contents

Executive summary

4

Background to the Trust

6

The consultation process

8

The consultation response

15

Appendix A – Key stakeholder organisations notified

33

Appendix B – Full meeting and event schedule

37

Alternative formats

39

Contact us and map of Trust sites

40


//Executive summary

The Trust’s ‘Working in Partnership’ foundation trust public consultation ran for three months, from Monday 11 November 2013 to Monday 10 February 2014. An important feature of the Trust’s application for foundation trust status is listening to the views of our patients, the people who work for us, the public and partner organisations. The consultation period was preceded by a pre-consultation period and followed by a period when all feedback was analysed and reviewed, and the Trust’s response was considered. During the consultation period the Trust circulated the consultation document, promoted and publicised the consultation programme, and organised and attended meetings to discuss the proposals for becoming a foundation trust. At the start of the consultation, an introductory email letter was sent out to: 550 individual stakeholders in 145 organisations; approximately 1,200 GP practices; and over 3,000 shadow foundation trust members, inviting them to take part in the consultation. In addition, 10,000 letters were sent to Trust outpatients who were due to have appointments during the consultation period. Internally, Trust staff received weekly email bulletins and were informed of the consultation progress via regular executive briefings and meetings. Externally, the Trust ‘tweeted’ about the consultation at least once each week. In addition, a series of materials promoting the consultation were placed around the main Trust hospital sites. The main methods of response were the printed response form with freepost envelope and the online questionnaire on the Trust website. Respondents could also comment by email, letter or by telephone. Three dedicated public/staff meetings were organised by the Trust. We approached each of the eight local authority health overview and scrutiny committees in north west London with a report, and offered to attend a scheduled meeting. A formal open meeting on the foundation trust application was also organised with Healthwatch Central West London. These meetings were intended to help organisations and individual members of the public make informed responses by providing the opportunity for discussion, and questions and answers. All meetings were attended by at least one Trust executive director or senior manager, who delivered a presentation or report, and took questions. A total of 545 formal responses were received along with a large number of individual comments recorded at the various meetings. The consultation on our foundation trust application demonstrated overall support for our plans and proposals. We have received a number of important comments, all of which have been carefully considered. As a result of this feedback we have been able to revise and strengthen our plans. It has been an opportunity for us to further engage with our local communities and strengthen relationships, which is a fundamental reason for becoming a foundation trust.


As a result, we are making changes to our proposals on the size and composition of the council of governors, which are subject to the formal agreement of the new foundation trust’s constitution. We believe that the consultation process has been robust and successful, reaching all of our target audiences, including patients, the people who work for us, partner organisations and the general public. We now have three main steps to take:

1. Provide feedback to those who took part in the consultation and communicate the results to all interested parties.

2. Submit our application to become a foundation trust to Monitor later in 2014. 3. Hold governor elections among our members and discuss with the nominated partner

organisations who will appoint governors and the process for doing this. We hope for a successful outcome to our application and look forward to becoming a foundation trust in the early part of 2015. We are confident that the governance arrangements we will put in place will ensure that becoming a foundation trust will:

► bring us closer to our patients and local communities ► further strengthen engagement with our people ► provide greater freedom to innovate and develop our services.


//Background to the Trust

Imperial College Healthcare NHS Trust was created in October 2007 by merging St Mary’s NHS Trust and Hammersmith Hospitals NHS Trust, and partnering with the faculty of medicine at Imperial College London. Now one of the largest NHS trusts in the country, in March 2009 we came together with Imperial College London to establish one of the UK’s first academic health science centres (AHSC). The Department of Health has re-designated the AHSC from April 2014 for a further five years. The Trust has consistently provided high-quality care by overall UK standards. We provided specialist care for patients from over 80 commissioners nationwide in 2012/13, as well as providing a comprehensive range of healthcare services to our local population of nearly two million people in north west London. The Trust is a centre of excellence, hosting the National Institute for Health Research’s largest Biomedical Research Centre in the UK.

Our hospitals There are five hospitals in the Trust: Charing Cross Hospital Charing Cross is a general hospital that provides a range of adult clinical services. The hospital currently hosts one of eight hyper-acute stroke units in London. It is also a key site for teaching medical students from Imperial College London. Hammersmith Hospital Hammersmith is a general hospital and is well known for its research achievements, hosting a large community of Imperial College London postgraduate medical students and researchers. The hospital hosts the heart attack centre for north west London. Queen Charlotte’s & Chelsea Hospital Queen Charlotte’s & Chelsea provides maternity, and women’s and children’s services. The hospital has extensive high-risk services and cares for women with complicated pregnancies. The hospital also has a midwife-led birth centre for women with routine pregnancies who would like a natural childbirth experience. St Mary’s Hospital St Mary’s is a general acute hospital that diagnoses and treats a range of adult and paediatric conditions. The hospital also provides maternity services and hosts one of four major trauma centres for London. Western Eye Hospital Western Eye Hospital is dedicated to ophthalmology. It offers the only 24-hour emergency eye care service in west London. Imperial College London Imperial College London has a campus on each of our main sites and is closely integrated with all of our clinical specialties.


Our services The Trust treats patients at every stage of life – from conception through to care of the elderly – with over 55 specialist services for both adults and children. These clinical services are organised into four clinical divisions:

► Investigative sciences and clinical support ► Medicine ► Surgery, cancer and cardiovascular ► Women’s and children’s

Contact details of person responsible for the consultation: Mick Fisher Head of Public Affairs Imperial College Healthcare NHS Trust St Mary’s Hospital Salton House Praed Street London W2 1NY Tel: 020 3312 7674 Email: [email protected]


//The consultation process

The consultation programme formed an important part of the development of the final application for foundation trust status and was delivered in three phases: 1. Pre-consultation

Pre-consultation communication and engagement took place from Monday 9 September 2013 to Friday 8 November 2013.

2. Public consultation

The public consultation programme ran from Monday 11 November 2013 to Monday 10 February 2014.

3. Consultation response

Analysis and review of, and response to, consultation feedback were undertaken from Monday 17 February 2014 to Wednesday 26 March 2014.

Pre-consultation In addition to preparing for the activities during the consultation period, the following pre-consultation activities were undertaken:

► Content developed for Trust Intranet ‘the Source’ ► Content development for Trust website ► Monthly item for ‘Team Brief’ publication and presentations at Chief Executive Open

Hour (monthly) and Chief Operating Officer ‘Team Brief’ sessions (twice per month) ► PowerPoint presentation internal/external ► Regular ‘In Brief’ electronic daily bulletin items ► Foundation trust application and forthcoming consultation featured at Trust Annual

General Meeting ► Key external stakeholder meetings ► External ‘Partner Update’ newsletter item

Internal meetings

Date Meeting

19 September Chief Executive Open Hour

October Chief Executive Open Forum (x 6)

3 and 11 October Chief Operating Officer Team Brief

5 and 6 November Chief Operating Officer Team Brief


External meetings

Date Meeting

10 September London Borough of Hammersmith & Fulham Housing, Health and Adult Social Care Select Committee

11 September Chair, Royal Borough of Kensington and Chelsea Adult Social Care and Health Scrutiny Committee

18 September MP for Westminster North

18 September Healthwatch Central West London

24 September London Borough of Ealing Health and Adult Social Services Standing Scrutiny Panel

25 September Westminster City Council Adults, Health and Community Protection Policy & Scrutiny Committee

25 September Trust Annual General Meeting

31 October MP for Westminster North and MP for Hammersmith

5 November MP for Kensington

7 November Westminster City councillors and chief executive

Consultation Introduction to the ‘Working in Partnership’ consultation document The consultation document was produced in electronic downloadable, interactive and printed formats. It was available in languages other than English, and alternative formats upon request. The contents were:

► Introduction ► Introduction from chair and chief executives ► About us ► What we do ► Performance highlights ► Our vision for the future ► Plans to improve ► Our values ► What is a foundation trust? ► Why we want to be a foundation trust ► Our proposals ► Council of governors ► Board of directors ► Let us know what you think ► Alternative formats ► Insert: response/membership application form and freepost envelope


There were 13 consultation questions set out in the document: Q1: Do you agree with our vision and strategy for the future? Q2: Do you agree that the minimum age for membership should be 16? Q3: Do you agree that the public constituency should encompass the whole of Greater

London? Q4: Do you agree that we should have a public and a patient constituency? Q5: Do you agree that the patient constituency should not be sub-divided to include carers? Q6: Do you agree that staff members should automatically become members of the Trust

unless they choose to opt out? Q7: Do you agree that only staff directly employed by the Trust should be eligible for staff

membership? Q8: Do you agree that the staff constituency should be sub-divided as clinical and non-

clinical? Q9: Do you agree with the proposed levels of engagement with our members as described? Q10: Do you agree with the proposed size and composition of the council of governors? Q11: Do you agree with the minimum age of governors being 16? Q12: Do you agree with our proposed arrangements for elections? Q13: Do you agree with our proposed plan for the board of directors? Consultation documents The following documents were made available in addition to the ‘Working in Partnership’ consultation document:

► PowerPoint presentation – overview of the Trust and foundation trust application. ► Local authority report – submission to each of the eight north west London health

overview and scrutiny committees (OSC).

In addition, the Trust website provided a dedicated section for the foundation trust consultation and information on how to become a member of the shadow organisation prior to authorisation being received. Document distribution Over 4,000 printed copies of the consultation document were distributed during the course of the consultation period. An electronic downloadable and interactive document was also made available through the Trust website. Printed copies were placed at main hospital receptions, Patient Advice and Liaison (PALs) offices and distributed to those attending the public, local authority health overview and scrutiny committee (OSC), Healthwatch Central West London meetings and other events. Publicity The Trust publicised the consultation using a range of communications to individuals and organisations across north west London, Greater London and England. At the launch of the consultation, an introductory email letter was sent out to: 550 individual stakeholders in 145 organisations; approximately 1,200 GP practices and over 3,000 shadow foundation trust members, inviting them to take part. A further email letter was sent at the start of the final month of the consultation period. A list of organisations is given in Appendix A. In addition, 10,000 letters publicising the consultation were sent to Trust outpatients who were due to have appointments during the consultation period.


A series of posters, pop-up banners, plasma screen and screensaver messages promoted the consultation around the main Trust hospital sites. Internally, Trust staff received weekly email bulletins and were informed via regular senior executive briefings and meetings. Externally, a press release was issued on 19 November, which was placed on the Trust website, and the consultation was tweeted at least once each week to its approximately 4,750 followers on Twitter. The Trust’s ‘360’ quarterly magazine and its electronic bulletins – ‘Partner Update’ for partner organisations and individual stakeholders, and, ‘GP bulletin’ for GP practices – also carried articles publicising the consultation. Response tools The Trust used a variety of tools to enable consultees to send us their responses. The most promoted methods were a printed response form with freepost envelope (inserted into the consultation document) and an online questionnaire accessed via the Trust website. In addition, there were other channels for responses and information requests:

► A dedicated email facility through [email protected] ► Telephoning the Trust’s communications team ► Briefing notes from public meetings and minutes of local authority health OSCs.

Consultation events Public meetings were organised in each of the following local boroughs: Kensington and Chelsea, Hammersmith & Fulham, and, Westminster. The meetings were organised and promoted using the internet site www.eventbrite.com. Briefing notes were taken at each meeting so that comments could be collated, analysed and used to inform the foundation trust application process. Public meetings

Date Venue

11 December Small Hall, Kensington Town Hall, Kensington 17 December Oak Suite, W12 Conference Centre, Hammersmith 16 January Great Western 2, Hilton Hotel, Paddington

A registration system was in operation for these events and the approximate number of attendees for each meeting was: Kensington: 25Hammersmith: 35Paddington: 75Total: 135 In addition, the tri-borough Healthwatch Central West London organised an open meeting for its members in Kensington and Chelsea, Hammersmith & Fulham and Westminster on the foundation trust application. This was held on 30 January in Ladbroke Grove, Royal Borough of Kensington & Chelsea. Approximately 30 people attended this meeting.


Local authority health overview and scrutiny committees The Trust approached each of the eight local authority health OSCs in North West London with a report and offered to attend a scheduled meeting. Eight OSC meetings were formally attended during the consultation period. The meetings were intended to help local authorities’ health OSCs make informed responses by providing the opportunity for discussion, and questions and answers. All were attended by at least one Trust senior executive or senior manager who delivered a presentation or report, and took questions. The meetings included a special tri-borough health OSC hosted by the Trust at St Mary’s Hospital, and jointly attended by councillors representing the three local boroughs of Kensington and Chelsea, Hammersmith & Fulham, and Westminster. Local authority meetings

Date Meeting

13 November London Borough of Hammersmith & Fulham Housing, Health and Adult Social Care Select Committee

18 November Westminster City Council Adults, Health and Community Protection Policy & Scrutiny Committee

5 December London Borough of Ealing Health and Adult Social Services Standing Scrutiny Panel

16 December London Borough of Harrow Health and Social Care Scrutiny Sub-committee

8 January Tri-borough: Kensington and Chelsea, Hammersmith & Fulham, Westminster Health Overview and Scrutiny Committee

21 January Westminster City Council Adults, Health and Community Protection Policy & Scrutiny Committee

23 January Royal Borough of Kensington and Chelsea Adult Social Care and Health Scrutiny Committee

4 February London Borough of Hounslow Health and Adults Care Scrutiny Panel

External meetings

Date Meeting

12 November Chief Executive Officer for Westminster Council

19 November MP for Cities of London and Westminster and MP for Westminster North

4 December Healthwatch Central West London

17 December MP for Hammersmith

19 December NHS North West London Chairs of clinical commissioning groups (CCGs)


15 January Westminster City Council Cabinet Member for Adults and Public Health, Chairs of NHS Central London and West London CCGs

16 January NHS North West London Chairs of CCGs

20 January Westminster City Council Task Force councillors group

28 January West London CCG

30 January Healthwatch Central West London Internal communications and engagement with Trust people Internal communications and engagement activities supported the foundation trust consultation programme. This included communications supporting:

► awareness of foundation trust application, rationale, timeline and key messages ► engagement in, and familiarity with, the emerging Trust strategy ► key workstreams on quality, strategy and finance.

Internally, foundation trust communications were integrated into existing Trust channels. Internal communications activities were aligned with the overall foundation trust application process and included:

► Updated dedicated foundation trust section on ‘the Source’ intranet ► Consultation internal launch: all-staff email sent; consultation document

published/distributed ► Regular updates at staff fora: Chief Executive ‘Open Hour’ and Chief Operating Officer

‘Team Brief’ sessions ► Regular updates and news in Trust communications channels: quarterly ‘360’ newsletter,

daily’ In Brief’ electronic bulletin, and monthly ‘Team Brief’ publication ► Joint public/staff meetings in Kensington, Hammersmith and Paddington ► Internal pop-up banners, posters, plasma screen messages and screensavers ► Dedicated [email protected] email address

Internal meetings

Date Meeting

13 November Chief Executive Open Hour

4 December Chief Executive Open Hour

5 and 12 December Chief Operating Officer Team Brief

2 and 16 January Chief Operating Officer Team Brief

3 February Chief Operating Officer Team Brief


Consultation response Following the consultation period, the Trust analysed, reviewed and considered all the feedback received. This process involved the foundation trust project team. The consultation findings were submitted for review by the Foundation Trust Programme Board at its meeting held on 18 March, and the Trust’s board of directors received a formal report for its consideration at its public meeting held on 26 March. A summary of the results of the consultation and the Trust response were made publicly available in April. The consultation findings will help shape the final application for foundation trust status, expected to be submitted later in 2014.


//The consultation response

Analysis of responses The general tenor of the majority of responses was supportive of the overall direction and objectives of the foundation trust application. This analysis concentrates on the suggestions for change to the Trust proposals, but these need to be balanced with the positive comments of most respondents. Several responses were received on behalf of organisations, but the majority were received from individual members of the public. This analysis looks at the main general responses and at what was said on a question-by-question basis. It is intended to give a general sense of consultee responses, rather than to be an exhaustive list of comments received. All comments have, however, been taken into consideration as part of the final application process. Consultation responses Online questionnaires: 305 Response forms: 231 Emails/letters: 9 Total: 545 Responses on behalf of organisations were received from:

► Buckinghamshire New University ► Ealing Hospital NHS Trust and The North West London Hospitals NHS Trust ► Healthwatch Central West London ► London Borough of Hammersmith & Fulham ► Macmillan Cancer Support ► NHS West London Clinical Commissioning Group ► Royal Borough of Kensington and Chelsea ► Westminster City Council

The following section provides a summary of the answer choices provided by respondents who completed the online questionnaire and response form, with bar charts and tables containing breakdowns by percentage and actual numbers. Details of questionnaire responses Overall there was general support for our plans and proposals for becoming a foundation trust. We asked 13 questions in the consultation. Responses ranged between 48.5 and 78.5 per cent in favour for the 13 questions asked. The following questions in particular received majority (over 50 per cent) support: Q1: Do you agree with our vision and strategy for the future? Q2: Do you agree that the minimum age for membership should be 16? Q3: Do you agree that the public constituency should encompass the whole of Greater

London? Q4: Do you agree that we should have a public and a patient constituency?


Q6: Do you agree that staff members should automatically become members of the Trust unless they choose to opt out?

Q7: Do you agree that only staff directly employed by the Trust should be eligible for staff membership?

Q8: Do you agree that the staff constituency should be sub-divided as clinical and non-clinical?

Q9: Do you agree with the proposed levels of engagement with our members as described? Q11: Do you agree with the minimum age of governors being 16? Q12: Do you agree with our proposed arrangements for elections? Q13: Do you agree with our proposed plan for the board of directors? There were two questions where supportive responses were in the majority, but were slightly lower than 50 per cent of the total: Q5: Do you agree that the patient constituency should not be sub-divided to include carers? Q10: Do you agree with the proposed size and composition of the council of governors? A breakdown of the responses for each question and the Trust response is shown on the following pages. Q1: Do you agree with our vision and strategy for the future?

Analysis of individual comments (total 313) There were 117 generally favourable and supportive comments in relation to this question which featured the following words and phrases in a positive context: ‘high / quality / healthcare / education / research / AHSC / innovations / patient care / patient experience / staff / partnership’.


The majority of negative comments (115) provided by respondents answering this question related to concerns over future changes to the emergency departments and other services: ‘closure / downgrade / beds reduced / land sales / save our hospitals’ – at Charing Cross Hospital and Hammersmith Hospital. This was also the case when attendees at the public meetings raised the issue of changes already consulted upon under the ‘Shaping a healthier future’ programme and subject to the Secretary of State for Health’s announcement made on 30 October 2013. Five of the ‘no’ respondents mentioned ‘private control / privatisation’ in their comments. Of the respondents answering ‘no’, 32 answered Question 1 only (entering no responses for the subsequent questions 2-13). Several comments, particularly in the written submissions from local authorities and during the public meetings, were based on requests for more detailed information about the Trust’s clinical and site strategies, and the business cases providing financial and development plans. Some comments expressed a lack of understanding about how becoming a foundation trust would enable the Trust to achieve its strategic objectives and benefit patients. During the presentation of the strategic objectives at the public meetings, it was highlighted that objective four relating to the academic health science centres/networks benefits to patients was perhaps difficult to understand. Trust response The timing of the foundation trust consultation period meant it started shortly after the Secretary of State for Health’s announcement of his decisions on the ‘Shaping a healthier future’ programme made on 30 October 2013. The Trust’s emerging vision and strategy as set out in the consultation document therefore reflected the current state of development, as at the end of October. In subsequent months further detailed work has been undertaken – for example on the development of the Trust’s ‘Integrated Business Plan’ and ‘Outline Business Case’ for redevelopment of our hospital sites to create buildings and infrastructure that will allow us to deliver the services needed for the future, at a high standard of quality and affordability – to inform how the Trust intends to proceed in line with this strategic approach. The Trust intends to provide further updated information on the development of its plans to implement its clinical strategy across the three main hospital sites.


Q2: Do you agree that the minimum age for membership should be 16?

Analysis of individual comments (total 220) There were 69 comments from those respondents answering ‘yes’ to this question who used the following words and phrases in a favourable and supportive context: ‘mature / understand / sensible / young person’s point of view / informed / vision / involvement / empowering’. The majority of comments (87) provided by respondents answering ‘no’ to this question related to the view that at 16 years of age members would lack maturity and experience, suggesting minimum ages of 18 or 21 upward: ‘too young / not old enough / not mature enough / not enough life experience / should be voting age / should be 18 / should be 21’. Five comments specified that the minimum age should be ‘under 16’ or specified a minimum age of 14. Similar themes run through the comments from the ’no’ respondents on Q11, ‘Do you agree with the minimum age of governors being 16?’. Trust response The responses and feedback to this question should be considered in conjunction with those made to Question 11, concerning the minimum age of governors. It is important that the Trust develops and maintains appropriate and effective channels of information and involvement for all its patients. The Trust is proceeding with the minimum age of 16 for membership and will review its methods for communication and engagement with younger patients, particularly those under 16 years of age.


Q3: Do you agree that the public constituency should encompass the whole of Greater London?

Analysis of individual comments (total 209) There were 64 comments from those respondents answering ‘yes’ to this question who used the following words and phrases in a favourable and supportive context: ‘specialist / tertiary / referrals / patients all over London / views of all / population of Greater London’. The majority of comments (72) provided by respondents answering ‘no’ to this question related to the view that Greater London was too large an area and unrepresentative of the local public interested in the Trust and the geographical location of its hospitals: ‘too big / too large / too wide / not familiar with geographical area / feeling of ownership / reflect the local catchment area /should be west-north west London’. Similar themes concerning the public constituency run through the comments from the ‘no’ respondents on Q10 ‘Do you agree with the proposed size and composition of the council of governors?’. Trust response The responses and feedback to this question should be considered in conjunction with those made to Question 10, concerning the size and composition of the council of governors. While providing the same comprehensive range of healthcare services to the local population of nearly two million people resident in north west London, the Trust provided over 55 specialist services for patients from over 80 commissioners covering the rest of Greater London and nationwide in 2012/13.


The Trust believes that it would benefit from the involvement of members across the Greater London area who share an interest in our services. The Trust is proceeding with a single public constituency for Greater London, covering the 32 London Boroughs and the City of London, and will consider a geographical sub-division of the seats allocated to the public constituency on the council of governors (see Question 10). Q4: Do you agree that we should have a public and patient constituency?

Analysis of individual comments (total 176) The comments from those respondents answering ‘yes’ to this question used the following words and phrases in a favourable and supportive context: ‘patients and the public: must be included as they are customers / should have a voice / must be included’. Two specific issues raised in this area were how the Trust would distinguish between the two constituencies, and whether a patient member would transfer to the public constituency if they had received treatment over five years ago. Trust response Foundation trusts can choose if they wish to add a constituency for patients, and we believe this would be a means of bringing the Trust closer to our patients; ensuring that we are listening and responding to their views. Patients bring a different perspective than wider members of the public, based on their direct experience of our care. It would not be possible for the same individual to be a member in both the public constituency and the patient constituency at the same time. Once a member of the patient constituency is no longer eligible for membership, after five years since their last episode of care, they would be offered membership of the public constituency based on meeting the required criteria.


The Trust is proceeding with three membership constituencies: public, patient and staff. Q5: Do you agree that the patient constituency should not be sub-divided to include carers?

Analysis of individual comments (total 184) This question received the lowest percentage of respondents answering ‘yes’. The 55 comments from those respondents answering ‘yes’ to this question used the following words and phrases in a favourable and supportive context: ‘simplicity / too many sub divisions / unnecessary / can join public constituency’. The 22 comments from those respondents answering ‘don’t know’ used words/phrases such as: ‘uncertain / further information / specify carers / question confusing / badly worded question / not clear / do not understand question / not enough information / agnostic’. The majority of comments (44) provided by respondents answering ‘no’ to this question related to the view that carers would provide a valuable viewpoint based on their experience, using words/phrases such as: ‘understanding / voice / experience / different view’. Trust response The Trust recognises the valuable role and contribution made by carers, and the potential benefits from their involvement in our activities. However, we feel that a sub-division of the patient constituency would increase the complexity of the governance arrangements. An alternative method of ensuring carers’ involvement would be to encourage their membership of the public constituency and for the Trust to consider a ‘ring-fenced’ nominated partner as a


voluntary organisation. Also see Question 10, concerning the size and composition of the council of governors. The Trust is proceeding with the patient constituency without any sub-divisions and will consider ‘ring-fencing’ the nominated partner seat for the voluntary organisation for a carer organisation on the council of governors (see Question 10). Q6: Do you agree that staff members should automatically become members of the Trust unless they choose to opt out?

Analysis of individual comments (total 179) The comments from those respondents answering ‘yes’ to this question used the following words and phrases in a favourable and supportive context: ‘stakeholders / partners / commitment / accountability / active / ownership / loyalty / involved / have their say / staff satisfaction and patient experience / motivate / contributors / included’. The specific concerns raised were about ensuring actively engaged staff as members, and clearly stating they could opt out and how. Trust response While the Trust believes that this proposal would be a means of bringing the Trust closer to our people, ensuring that we are listening and responding to their views, we will consider appropriate methods for communicating the choice for individuals to opt out. The Trust is proceeding with the automatic enrolment of directly employed staff as members of the foundation trust.


Q7: Do you agree that only staff directly employed by the Trust should be eligible for staff membership?

Analysis of individual comments (total 172) The comments from those respondents answering ‘yes’ to this question generally felt that permanent, directly employed staff should be eligible for membership and other types of staff could join the public constituency. The comments from those respondents answering ‘no’ to this question mainly suggested that all staff, including temporary, contract staff, should be eligible for staff membership. Trust response While the Trust recognises the contribution made by contractor and short-term temporary staff, it is felt that allowing their membership to the staff constituency would create a disproportionate administrative burden and increase the complexity of the governance arrangements. However, as an alternative, the Trust should encourage contractor and short-term temporary staff to become members of the public constituency, provided they meet the required criteria. The Trust is proceeding with staff membership for any current employee of the Trust with a permanent, temporary or fixed-term contract for at least 12 months.


Q8: Do you agree that the staff constituency should be sub-divided as clinical and non-clinical?

Analysis of individual comments (total 172) The comments (66) from those respondents answering ‘yes’ to this question used the following words and phrases in a favourable and supportive context: ‘broader base / different experiences / specific view / different but complementary’. Comments (37) provided by respondents answering ‘no’ to this question related to the view that they did not understand the reason for a division, feeling it was a waste and some thought it ran against effective team building across all Trust staff. Trust response The Trust values the engagement and involvement of all the people working for us in the development and delivery of our services. However, the Trust believes that input from the staff constituency should be broadly representative of its average breakdown between clinical and non-clinical employees – in 2012/13 the Trust’s 9,500 employees were made up of approximately 7,500 clinical and 2,000 non-clinical. The Trust is proceeding with the sub-division of the staff constituency into two sections: clinical and non-clinical.


Q9: Do you agree with the proposed levels of engagement with our members as described?

Analysis of individual comments (total 141) The comments from those respondents answering ‘yes’ to this question favoured the flexibility for engagement provided by the various levels of membership. The main comment provided by respondents answering ‘no’ to this question related to the view that it would be unequal, and a complicated and bureaucratic system of membership. Trust response The Trust welcomes and values the engagement of each and every one of its members, but recognises that individuals will wish to choose how often and to what extent they wish to be involved. The Trust is proceeding with the three levels of membership as described in the consultation document: informed, involved and active.


Q10: Do you agree with the proposed size and composition of the council of governors?

Analysis of individual comments (total 170) This question received the highest percentage of respondents answering ‘don’t know’. The comments (67) from those respondents answering ‘yes’ to this question used the following words and phrases in a favourable and supportive context: ‘reasonable distribution / well represented / balanced / not unwieldy / right size / not too big / good balance / appropriate / good number / fair representation’. The comments (49) questioning the size and composition of the council of governors included both that it was too big and that it was too small. Several comments related to the balance of representation and suggested additional seats for local authorities and commissioners. Specific suggestions were made by the local authorities in Kensington and Chelsea, Hammersmith & Fulham, and Westminster. Several attendees at the public meetings also made similar comments. It should be noted however, that one formal response was received from NHS West London CCG out of the eight CCGs in north west London, suggesting increasing representation from the local CCGs. Some comments said there should be more seats for non-clinical staff and additional seats for local authorities in Ealing and Hounslow. In addition, other specific comments focused on a nominated partner seat for Healthwatch.


Other comments were made about limiting the terms of governors’ office to less than three terms and raising concerns about the council of governors lacking the necessary powers to hold the board of directors to account. Trust response The council of governors is the body through which the membership maintains dialogue with the Trust board of directors, and it is important that it can fulfil its role and responsibilities effectively. While increasing the number of seats in certain constituencies, and for specific nominated partners, may appear responsive to suggestions for increased representation, this should be balanced with the need to avoid a council which is too large, unwieldy and unable to operate effectively. As stated earlier (under Question 3), the Trust provides over 55 specialist services for both adults and children, and in 2012/13 we provided specialist care for patients from over 80 commissioners nationwide. While providing the same comprehensive range of healthcare services to the local population of nearly two million people resident in north west London, the Trust believes that it would benefit from the involvement of governors elected from across the Greater London area who share an interest in our services. Being an AHSC brings significant benefits for our patients, the people who work for us, students and the local population. This we believe warrants allocating three seats for AHSC partners. For similar reasons, the Trust’s close integration with Imperial College London means we wish to proceed with one allocated seat for this university. We see achieving foundation trust status as a means towards bringing the Trust closer to our patients and local communities, and partner organisations including Healthwatch who work on behalf of patients and the public to ensure they have their say about the NHS. The Trust sees the continued development of a strong working relationship with Healthwatch as an important part of our approach to improving the experiences of our patients and their carers while in contact with our services. The Trust is keen to ensure that governors with an active interest in its activities are able to contribute over a suitable length of time, which will provide the opportunity to develop an individual governor’s expertise and maintain appropriate continuity for the governance of the organisation. We therefore intend to proceed with a maximum term of office of nine years (also see Question 12). The Trust is committed to providing a programme of ongoing development and support for all governors, both as individuals and as a group, to ensure they are able to effectively fulfill their important roles and responsibilities. The Trust is proceeding with our proposals for the size and composition on the council of governors with the following specific changes, which are subject to the formal agreement of the new foundation trust’s constitution:

► Sub-dividing the eight seats allocated to the public constituency so that five are elected from members living in north west London (eight boroughs) and three are elected for the rest of Greater London (24 boroughs and the City of London). Also see Question 3.

► Increasing by one the number of seats allocated to the patient constituency, giving a total of nine seats for this constituency.


► Increasing by one the number of seats allocated to CCGs, giving a total of two seats for this constituency.

► Increasing by two seats the total number of seats on the council of governors, giving a total of 33 seats for the council.

► Specifying that the two seats allocated to CCGs are specifically in relation to the eight CCGs in north west London, and that the process for deciding how these seats are filled is their responsibility.

► Specifying that the two seats allocated to local authorities are specifically ‘ring-fenced’ to the two local authorities in which the Trust’s three main hospital sites are geographically located, i.e., London Borough of Hammersmith & Fulham and Westminster City Council respectively, and that the process for filling the one seat allocated to each local authority is their responsibility.

► Specifying that the one seat allocated to an independent medical charity is specifically ‘ring-fenced’ to the Association of Medical Research Charities, and that the process for deciding how this seat is filled is their responsibility.

► Specifying that the one seat allocated to a voluntary organisation is specifically ‘ring-fenced’ to be filled by an organisation representing carers.

Proposed size and composition of the council of governors

Final size and composition of the council of governors

Public seats 8 Public seats 8 Patient seats 8 Patient seats 9 Staff seats 5 Staff seats 5 Partners 10 Partners 11 Total 31 Total 33

Partners Clinical commissioning groups 2 NHS England 1 Local authorities 2 University: Imperial College London 1 AHSC partners 3 Independent medical charity 1 Voluntary organisation 1 Total 11


Q11: Do you agree with the minimum age of governors being 16?

Analysis of individual comments (total 203) This question received the highest percentage of respondents answering ‘no’. The majority of comments (108) provided by respondents answering ‘no’ to this question related to the view that at 16 years of age governors would lack maturity and experience, suggesting minimum ages ranging from a minimum of 18/21, and up to 30 years of age. Similar themes run through the comments from the ’no’ respondents on Question 2, ‘Do you agree with the minimum age of governors being 16?’. Trust response The responses and feedback to this question should be considered in conjunction with those made to Question 2, concerning the minimum age of members. It should also be noted that it is a requirement of Monitor, the regulator of health services in England, that all governors of foundation trusts be aged 16 years or over. The Trust understands the reasons for a significant number of respondents advocating a higher minimum age for governors. As stated above (see Question 10), however, the Trust is committed to providing a programme of ongoing development and support for all governors, both as individuals and as a group, to ensure they are able to effectively fulfill their important roles and responsibilities. The Trust is proceeding with 16 as the minimum age for governors, while specifying that this relates to being 16 or over at the closing date for nominations to stand for election as a governor.


Q12: Do you agree with our proposed arrangements for elections?

Analysis of individual comments (total 143) The comments (95) from those respondents answering ‘yes’ to this question used the following words and phrases in a favourable and supportive context: ‘reasonable / workable / open / fair’. Comments (31) from respondents who said ‘no’ gave the view that nine years for maximum terms of office was too long, and suggested a voting system using proportional representation. Some questions were asked about which organisation would be the ‘independent third party’ organising elections. Trust response As stated above (see Question 4), it would not be possible for the same individual to be a member of both the public constituency and the patient constituency at the same time. As such, an individual member would vote in elections for governor candidates drawn from their own constituency using the ‘first past the post’ system. As stated above (see Question 10), the Trust is keen to ensure that governors with an active interest in its activities and affairs are able to contribute over a suitable length of time, providing the opportunity to develop an individual governor’s expertise and maintain appropriate continuity for the governance of the organisation. We therefore intend to proceed with a maximum term of office of nine years. The Trust is proceeding with the proposed arrangements for elections.


Q13: Do you agree with our proposed plan for the board of directors?

Analysis of individual comments (total 149) The comments (71) from those respondents answering ‘yes’ to this question used the following words and phrases in a favourable and supportive context: ‘appropriate / sounds right / standard practice / fairly standard / recognised structure / logical / well balanced’. Several comments from respondents answering ‘don’t know’ (23) asked for more detailed information on the composition of the board of directors and how non-executive directors would be appointed. A specific suggestion was for Imperial College London to be allocated a non-executive director position on the board of directors, rather than holding a nominated partner seat on the council of governors. Comments from respondents who answered ‘no’ (23) were largely based on overall opposition to the foundation trust application and service reconfiguration decisions under the ‘Shaping a healthier future’ programme. Trust response The detailed plan for the board of directors is currently being formulated as the draft constitution for the prospective foundation trust is given further consideration. The Trust is proceeding with the proposed plan for the board of directors as set out in the consultation document.


Feedback This document is available online. Printed copies of this full Trust response document will also be available on request. We are producing a summary of the Trust response to the consultation findings and we will communicate this, using both printed and electronic versions, to the individuals and groups we initially aimed to consult with, whether they took part in the consultation or not. There will also be publicity through our usual Trust communication channels. Every individual who took part in the consultation, and for whom we hold an email address, will receive the summary document in electronic format, attached to an email thanking them for taking part. The organisations which took part will also receive the document, and a letter which will address the specific issues they raised.


//Appendix A – Key stakeholder organisations notified

Academy of Medical Royal Colleges

Academy of Medical Sciences

Age UK Brent

Age UK Ealing

Age UK Hammersmith & Fulham

Age UK Hounslow

Age UK Kensington & Chelsea

Alzheimer’s Society Hammersmith & Fulham

Arthritis Research UK

Ashford and St Peter’s Hospitals NHS Foundation Trust

Association of Medical Research Charities

Association of UK University Hospitals

Asthma UK

Barnet and Chase Farm Hospitals NHS Trust

BME Health Forum

British Dental Association

British Heart Foundation

British Liver Trust

British Lung Federation

British Medical Association

Buckinghamshire New University

Cambridge University Hospitals NHS Foundation Trust

Cancer Research UK

Care Quality Commission

Carnall Farrar

Central London Community Healthcare NHS Trust

Central Manchester University Hospitals NHS Foundation Trust

Central and North West London NHS Foundation Trust

Chelsea and Westminster Hospital NHS Foundation Trust

College of Emergency Medicine

Community and Voluntary Sector Association Hammersmith & Fulham

Department of Health

Diabetes UK

European Parliament

Friends of St Mary’s Hospital

Fulham Black Community

General Medical Council


GK Strategy

Greater London Authority

Guy’s and St Thomas’ NHS Foundation Trust

Hammersmith & Fulham Circle

Harrow in Business

Health Education England

Healthwatch Brent

Healthwatch Central West London

Healthwatch Ealing

Healthwatch Harrow

Healthwatch Hillingdon

Healthwatch Hounslow

Heatherwood and Wexham Park Hospitals NHS Foundation Trust

The Hillingdon Hospitals NHS Foundation Trust

Hounslow and Richmond Community Healthcare NHS Trust

House of Commons

Human Tissue Authority

Imperial College Health Partners

Imperial College Academic Health Science Centre

Imperial College London

Iranian Association

Iraqi Community Association

Irish Cultural Centre Hammersmith

King’s College Hospital NHS Foundation Trust

Kingston Hospital NHS Foundation Trust

Kurdish Association

London Ambulance Service NHS Trust

London Assembly

London Borough of Brent

London Borough of Camden

London Borough of Ealing

London Borough of Hammersmith & Fulham

London Borough of Harrow

London Borough of Hillingdon

London Borough of Hounslow

London Borough of Lambeth

London Borough of Richmond

London Borough of Southwark

London Borough of Wandsworth

London Communications Agency

London Councils


London Health Programmes

London Medical Council

Londonwide Local Medical Committees

Macmillan Cancer Support

Medical Research Council

Medical Schools Council

Monitor

The Newcastle upon Tyne Hospitals NHS Foundation Trust

National Institute for Health Research

NHS Brent Clinical Commissioning Group

NHS Brent Harrow Hillingdon Collaborative

NHS Central London Clinical Commissioning Group

NHS Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Collaborative

NHS Ealing Clinical Commissioning Group

NHS England

NHS Hammersmith & Fulham Clinical Commissioning Group

NHS Harrow Clinical Commissioning Group

NHS Hillingdon Clinical Commissioning Group

NHS Hounslow Clinical Commissioning Group

NHS Litigation Authority

NHS North East London Commissioning Support Unit

NHS North West London Commissioning Support Unit

NHS Shaping a healthier future programme

NHS Trust Development Authority

The North West London Hospitals NHS Trust

Nuffield Trust

Nursing and Midwifery Council

Oxford University Hospitals NHS Trust

Public Health England

Royal Borough of Kensington and Chelsea

Royal Brompton & Harefield NHS Foundation Trust

Royal College of Anaesthetists

Royal College of General Practitioners

The Royal College of Midwives

Royal College of Nursing

Royal College of Obstetricians & Gynaecologists

Royal College of Ophthalmologists

Royal College of Paediatrics and Child Health

Royal College of Pathologists

Royal College of Physicians

Royal College of Radiologists


Royal College of Surgeons

Royal Free London NHS Foundation Trust

Sheffield Teaching Hospitals NHS Foundation Trust

Somali Caring and Education Association

Somali Community Support Centre

Somali Women Support and Development Group

Somali Women’s Association

St George’s Healthcare NHS Trust

The Asian Health Agency

The King’s Fund

The Royal Marsden Hospital NHS Foundation Trust

The Stroke Society

The Stroke Association

The Wolfson Foundation

Tri-Borough Adult Social Care

Universities UK

University College London Hospitals NHS Foundation Trust

University Hospitals Birmingham NHS Foundation Trust

University of West London

Voluntary Action Westminster

Wellcome Trust

West London Breast Screening Service

West London Mental Health NHS Trust

West Middlesex University Hospital NHS Trust

Westminster City Council

White City Community Centre


//Appendix B – Full meeting and event schedule

Pre-consultation period: Monday 9 September to Friday 8 November 2013 Internal meetings

Date Meeting

19 September Chief Executive Open Hour

October Chief Executive Open Forum (x 6)

3 and 11 October Chief Operating Officer Team Brief

5 and 6 November Chief Operating Officer Team Brief External meetings

Date Meeting

10 September London Borough of Hammersmith & Fulham Housing, Health and Adult Social Care Select Committee

11 September Chair, Royal Borough of Kensington and Chelsea Adult Social Care and Health Scrutiny Committee

18 September MP for Westminster North

18 September Healthwatch Central West London

24 September London Borough of Ealing Health and Adult Social Services Standing Scrutiny Panel

25 September Westminster City Council Adults, Health and Community Protection Policy & Scrutiny Committee

25 September Trust Annual General Meeting

31 October MP for Westminster North and MP for Hammersmith

5 November MP for Kensington

7 November Westminster City councillors and chief executive

Consultation period: Monday 11 November 2013 to Monday 10 February 2014 Internal meetings

Date Meeting

13 November Chief Executive Open Hour

4 December Chief Executive Open Hour


5 and 12 December Chief Operating Officer Team Brief

2 and 16 January Chief Operating Officer Team Brief

3 February Chief Operating Officer Team Brief External meetings

Date Meeting

12 November Chief Executive Officer for Westminster Council 13 November London Borough of Hammersmith & Fulham

Housing, Health and Adult Social Care Select Committee 18 November Westminster City Council

Adults, Health and Community Protection Policy & Scrutiny Committee

19 November MP for Cities of London and Westminster, and MP for Westminster North

4 December Healthwatch Central West London 5 December London Borough of Ealing

Health and Adult Social Services Standing Scrutiny Panel 11 December Public Meeting: Small Hall, Kensington Town Hall,

Kensington 16 December London Borough of Harrow

Health and Social Care Scrutiny Sub-committee 17 December MP for Hammersmith

19 December NHS North West London Chairs of CCGs 8 January Tri-borough: Kensington and Chelsea, Hammersmith &

Fulham, Westminster Health Overview and Scrutiny Committee

17 December Public Meeting: Oak Suite, W12 Conference Centre, Hammersmith

15 January Westminster City Council Cabinet Member for Adults and Public Health, Chairs of NHS Central London and West London CCGs

16 January NHS North West London Chairs of CCGs

16 January Public Meeting: Great Western 2, Hilton Hotel, Paddington

20 January Westminster City Council Task Force councillors group 21 January Westminster City Council

Adults, Health and Community Protection Policy & Scrutiny Committee

23 January Royal Borough of Kensington and Chelsea Adult Social Care and Health Scrutiny Committee

28 January West London CCG

30 January Healthwatch Central West London 4 February London Borough of Hounslow

Health and Adults Care Scrutiny Panel


//Alternative formats

Alternative formats for this report This document is also available in other languages, large print and audio format on request. Please contact the communications directorate on 020 3312 7674 for further details.


//Contact us and map of Trust sites

Contact us Charing Cross Hospital Fulham Palace Road London W6 8RF Tel: 020 3311 1234

Queen Charlotte’s & Chelsea Hospital Du Cane Road London W12 0HS Tel: 020 3313 1111

Western Eye Hospital Marylebone Road London NW1 5QH Tel: 020 3312 6666

Hammersmith Hospital Du Cane Road London W12 0HS Tel: 020 3313 1000

St Mary’s Hospital Praed Street London W2 1NY Tel: 020 3312 6666

Imperial College London South Kensington Campus London SW7 2AZ Tel: 020 7589 5111


Respect our patients and colleagues Encourage innovation in all that we do

Provide the highest quality care Work together for the achievement of outstanding results

Take pride in our success

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