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80-569: University Hospitals of Morecambe Bay NHS Foundation Trust ( UHMB or UHMBT ) is an NHS Foundation Trust in North West England, providing services in South Cumbria and North Lancashire in the Morecambe Bay area. It has about 6,000 employees and provides services for some 350,000 people. It provides services at: The Trust was the first to deploy Lorenzo patient record systems in

160-402: A cap on the proportion of their income that can come from non-NHS treatments. It did not only apply to income derived from individual patients, it covered income from all non-NHS sources. This could include joint ventures to develop medical technologies, employers paying for counselling services or income from treating UK military personnel overseas. The Health and Social Care Act 2012 abolished

240-446: A decentralized system, it attempts to establish certain basic, common safeguards throughout the country. This law attempts to establish collaboration of public health authorities with respect to benefits provided, pharmacy, health professionals, research, health information systems, and the overall quality of the health system. Toward these ends, the law created or empowered several specialized organs and agencies, all of which are open to

320-462: A health care system sufficient for the needs of their respective jurisdictions. Article 149.1.16 or the Constitution, a further basis for the present law, establishes substantive principles and criteria that allow general and common characteristics to be consistent throughout the new system, providing a common basis for health services throughout Spanish territory. The administrative device set up by

400-643: A la Dependencia y a la Discapacidad ). The objective of this reorganization is to reinforce the role of the single ministry as the instrument of cohesion for the National Health System (SNS), adding to the portfolio of the Secretary General of Health purview in matters of the quality of the SNS by adding to it the Agency of Quality of the National Health System ( Agencia de Calidad del Sistema Nacional de Salud ) and

480-487: A link between the community and the board of directors. The size of the council of governors and its exact composition are determined by the constitution of the particular trust. Each trust adopts its own constitution subject to certain restrictions in legislation. These restrictions include that a majority of the council of governors must be elected governors and governors must be unpaid volunteers. Some trusts are more committed to co-operative principles and have even written

560-819: A new organisation – the NHS Trust Development Authority – was established by the Health and Social Care Act 2012 to supervise trusts which have not reached foundation status, of which there were 99 in April 2013, 47 of which were never expected to reach foundation status. The Health and Social Care Bill 2011 , overseen by Lansley, proposed that all NHS trusts become foundation trusts or part of an existing foundation trust by April 2014. The early foundation trusts were generally financially buoyant, but during 2013 and 2014 more faced financial difficulties. A foundation trust finance facility, managed by an advisory committee to

640-514: A plenary body, by delegated committees, through technical commissions, and through work groups. It meets as a plenary body at the initiative of its president or at the initiative of one-third of its members; plenary meetings occur at least four times a year. To some extent, this is a formality: resolutions from CISNS commissions are typically adopted by consensus. Cooperation agreements to conduct joint health actions are formalized in CISNS agreements. Under

720-738: A population between 5,000 and 20,000 inhabitants. The Basic Health Zone is served by a single general hospital and specialists' center. Article 12 of the Law of Cohesion establishes the concept of "primary care," the basic level of patient care that guarantees the comprehensiveness and continuity of care throughout the patient's life, acting as manager and coordinator of cases and regulator of issues. Primary care includes health promotion, health education, prevention of illness, health care, maintenance and recuperation of health, as well as physical rehabilitation and social work. Primary health care includes service provided either on-demand, scheduled, or urgently, both in

800-404: A private company, and exempt from many of the rules normally imposed on state-owned hospitals, and in particular, that hospital was allowed to negotiate its own contracts with workers. The governance of that hospital includes local government, trade unions, health workers and community groups. Foundation trusts were announced by Health Secretary Alan Milburn in 2002, and the legislative basis

880-470: A right of all citizens, and Title VIII, which foresaw that purview over matters of health would devolve to the autonomous communities . The General Health Law of 1986 ( Ley 14/1986 General de Sanidad ) was formulated on two bases. First, it carries out a mandate of the Spanish Constitution, whose articles 43 and 49 establish the right of all citizens to protection of their health. The law recognizes

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960-460: A right to health services for all citizens and for foreigners resident in Spain. Second, Title VIII of the Constitution confers upon the autonomous communities broad purview in matters of health and health care. The autonomous communities have first-order importance in this area, and the law permits devolution of these functions from the central government to the autonomous communities, in order to provide

1040-470: A sector ( Dirección de sector ), or of a comarca , district, department, or other territorial unit used in that autonomous community. Although the autonomous communities differ among themselves in layering subdivisions of their health areas, all eventually come down to a Health Zone ( Zona de Salud ) or Basic Health Zone ( Zona Básica de Salud ) as the unit for a primary health care team. In Andalusia, for example, each existing Basic Health Zone takes care of

1120-570: A shared services solution". By the end of 2013–14, foundation trusts collectively had built up cash reserves of £4.3 billion and it was suggested in the NHS Five Year Forward View that the government would "support" foundation trusts to spend this money "to help local service transformation". In response, the chief executive of the Foundation Trust Network, Chris Hopson, said: "The responsibility for these surpluses lies with

1200-767: A variety of tests, which have changed over time. In 2003 only trusts with three stars from the Commission for Health Improvement were eligible for foundation status. In that year Aintree Hospitals, Essex Rivers Healthcare, Newcastle upon Tyne Hospitals and Walsall Hospitals were all downgraded to two stars and so did not make the first wave of foundation trusts. Formerly referred to as foundation trust equivalent (FTe) instead of Equivalent Foundation Trusts , this designation applies only to trusts providing high secure psychiatric services, of which there are three: Nottinghamshire Healthcare NHS Trust , West London Mental Health NHS Trust and Mersey Care NHS Trust . These trusts abide by

1280-432: Is a staff constituency, a patient constituency, and a "public member" constituency, consisting of members who are neither patients nor staff but live in a defined geographical area. In addition, there are governors appointed by bodies with whom the trust works in partnership. So, for example, appointments may be made by local councils, local medical schools, and local voluntary organisations. Governors are intended to act as

1360-569: Is described in Schedule 7 of the National Health Service Act 2006 , with the formal corporate form being called a "public benefit corporation". Each foundation trust has a council of governors. This is made up of elected governors and appointed governors. Elected governors are chosen by a secret postal ballot of the membership, which is open to the general public. The elections are usually held in separate constituencies. Typically there

1440-537: Is established in the laws of autonomic financing. Inclusion of a new service in the catalog of services of the National Health System is accompanied by an economic memo that contains the positive or negative financial impact it is expected to imply. This memo is brought up to the Council of Fiscal Policy and Finance for analysis and approval as to whether to proceed. Prior to 1986, public financing of health care occurred mostly through highly regressive payroll taxes. In 1986,

1520-556: Is expected to increase the trust's income by more than £20 million per year. NHS Foundation Trust Alan Milburn 's trip in 2001 to the Hospital Universitario Fundación Alcorcón in Spain is thought to have been influential in developing ideas around foundation status. That hospital was built by the Spanish National Health System , but its operational management is contracted out to

1600-430: Is jointly composed, and coordinates the basic lines of health policy in matters affecting contracts; acquisition of health and pharmaceutical products, as well as other related goods and services; as well as basic health personnel policies. The 2003 Law of Cohesion and Quality of the SNS introduced significant changes in the composition, functioning, and purview of the CISNS. Under this law, the CISNS functions variously as

1680-611: Is the agglomeration of public healthcare services that has existed in Spain since it was established through and structured by the Ley General de Sanidad (the "Health General Law") of 1986. Management of these services has been progressively transferred to the distinct autonomous communities of Spain, while some continue to be operated by the National Institute of Health Management ( Instituto Nacional de Gestión Sanitaria , INGESA), part of

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1760-627: The Furness General Hospital maternity ward deaths investigation , Cumbria Clinical Commissioning Group intends to maintain consultant-led maternity services at Furness General Hospital "for the foreseeable future". In June 2014 the trust was placed in special measures by Monitor (NHS) after safety and leadership were rated inadequate by the Care Quality Commission . Services at Westmorland General Hospital were given an overall rating of "good", but Furness General Hospital and

1840-576: The Ley General de Sanidad establishes the fundamental characteristics of the SNS: Public intervention in collective health problems has always been of interest to governments and societies, especially in the control of epidemics through the establishment of naval quarantines , the closing of city walls and prohibitions on travel in times of plague , but also in terms of hygienic and palliative measures. Al-Andalus — Muslim -ruled medieval Spain—was distinguished by its level of medical knowledge relative to

1920-697: The Ministry of Health and Social Policy (which superseded the Ministry of Health and Consumer Affairs— Ministerio de Sanidad y Consumo —in 2009). The activity of these services is harmonized by the Interterritorial Council of the Spanish National Health Service ( Consejo Interterritorial del Servicio Nacional de Salud de España , CISNS) in order to give cohesion to the system and to guarantee the rights of citizens throughout Spain. Article 46 of

2000-664: The Rochdale Principles into their constitution; they aspire to work closely and in partnership with other mutual and local organisations. At first, foundation trusts were authorised and regulated by Monitor , a non-executive body under the Department of Health. Monitor was merged into NHS Improvement in 2016. The trade body for foundation trusts is NHS Providers , formerly known as the Foundation Trust Network, which has 95% of all acute, ambulance, community and mental health foundation trusts in its membership. A 2014 report by

2080-541: The Socialist Health Association said that on the whole after 10 years, "Foundation Trusts [had]... not deepened in terms of democratic practice and participation". The independence of Foundation Trust governors was challenged in 2021 when the governors of Queen Victoria Hospital , a small specialist trust, called for a pause to plans for it to merge with University Hospitals Sussex NHS Foundation Trust . NHS Improvement were said to have effectively ordered

2160-583: The Spanish Civil War , the Ley de Bases de 1944 perpetuated this . The Law of 14 December 1942 create a system of obligatory health insurance under the already extant National Insurance Institute ( Instituto Nacional de Previsión , INP). The system was based on a percentage tax linked to employment. This was further modified by the General Law of Social Security ( Ley General de la Seguridad Social ) in 1974, toward

2240-566: The bienio progresista , the Law of 28 November 1855 established the basis for a General Health Directorate ( Dirección General de Sanidad ), which was created a few years later and which would last into the 20th century. The Royal Decree of 12 January 1904 approved the General Health Instruction ( Instrucción General de Sanidad ), which altered little of the 1855 scheme besides the name; the name would later change to General Inspectorate of Health ( Inspección General de Sanidad ). After

2320-638: The Charles III Institute of Health ( Instituto de Salud Carlos III ), the Institute of Health Information ( Instituto de Información Sanitaria ), the Quality Agency of the National Health System ( Agencia de Calidad del Sistema Nacional de Salud ) and the Observatory of the National Health System ( Observatorio del Sistema Nacional de Salud ). The basic organ of cohesion is the Interterritorial Council of

2400-520: The Councilors with purview over matters of health of the autonomous communities, elected by all of the Councilors who make up the body. The CISNS will come to know, debate among other things, and, as appropriate, make recommendations on the following matters: The prior functions shall be exercised without prejudice to the legislative purview of the Cortes Generales and, as appropriate, the norms of

2480-551: The Department of Health definition of a foundation trust, but the Secretary of State for Health maintains a direct line of communication and accountability with them because he or she has the responsibility to provide healthcare to patients who have been detained under the Mental Health Act , and have been judged to pose a grave and immediate danger to the public. Unlike full foundation trusts, governors have no statutory role, and

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2560-410: The Department of Health was promoting "A new type of NHS hospital". In 2011, the 116 trusts then in the pipeline to make applications were required to sign a formal agreement, with a deadline for the application to be made. Board members at a number of trusts which missed the deadline were sacked. It was accepted by Andrew Lansley that a number of trusts would never reach foundation trust status, and

2640-479: The Department of Health, was established to process loans for capital developments, but during 2014 applications were made by trusts which had trouble paying utility bills or replacing medical equipment. Guidance issued under the tenure of Jeremy Hunt in October 2014 said that conditions could be set which could include: reductions in the use of temporary staff, "use of collaborative procurement routes" or "the adoption of

2720-458: The FTs; any attempt by the statutory bodies to make a grab for them will be furiously resisted". By 2016, the distinction between foundation trusts and other NHS trusts was widely regarded as eroded, and in that year the two regulators were combined into a new body, NHS Improvement . The notion that every trust should become a foundation trust was abandoned, and the widespread financial crisis undermined

2800-489: The Foundation Trust Network it was raised to 1.5%. These caps disappeared on 1 October 2012. Collective earnings from private patients increased 14%, from £346.1 million in 2012–13 to £395.9 million for 2014–15. Private earning is concentrated on specialist hospitals in London who see many patients from other countries. Most trusts have negligible private income. In order to achieve foundation trust status, NHS trusts have to pass

2880-592: The General Administration of the State; likewise the normal developmental, executive and organizational purview of the autonomous communities. Article 41 of the General Health Law establishes that: The State finances, through general taxes, all health benefits and a percentage of pharmaceutical benefits. This tax is shared among the several autonomous communities according to various sharing criteria now that

2960-544: The General Directorate of Advanced Therapies and Transplants ( Dirección General de Terapias Avanzadas y Trasplantes ). The General Health Law of 1986 created the Interterritorial Council of the Spanish National Health Service ( Consejo Interterritorial del Servicio Nacional de Salud , CISNS) as the organ of general coordination in matters related to health between the central State and the autonomous communities who were given authority in health matters under that law. It

3040-430: The General Health Law sets out that ayuntamientos — municipal governments —have the following responsibilities with respect to health, without prejudice to the purview of other public administrative bodies: As a consequence of the decentralization contemplated by the Spanish Constitution, each autonomous community has received adequate transfers to create a health service, the administrative structure that manages all of

3120-458: The Law of Cohesion establishes that the financing of the Spanish health system is the responsibility of the autonomous communities in conformity with the accords of transfer and the current system of autonomic financing, notwithstanding the existence of a third party liable to pay. Sufficient financing of services is determined by the resources assigned to the autonomous communities in conformity to what

3200-422: The Law of Cohesion, CISNS functions mainly through the adoption of and compliance with joint accords, through the political use of the plenary sessions, with each member making an uncompromising defense of the interests of its region. Presentations, committees, and working groups have been very important, some more than others. Important committees include: Articles 69, 70 and 71 of the Law of Cohesion regulate

3280-589: The NHS because its remote location made it impossible to manage within the national Payment by Results tariff. In July 2015 the trust was the first, and so far only, to get an increase in the NHS tariff for its services agreed by Monitor (NHS) because of its "increased costs associated with this trust running health services across multiple sites in rural locations". It will get paid more per episode for accident and emergency, surgery, trauma and orthopaedics, paediatrics, women's health, and non-elective medical conditions. This

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3360-527: The NHS to reconsider "whether the model of foundation trusts is sensible", arguing "If one-third of the hospital system is permanently not demonstrating good viability and good governance, is that telling you something about actually how the system should run as opposed to how we thought it should run?". In January 2022 Sajid Javid , writing in The Times said he was planning a “revolution” that would allow “well-run hospitals more freedom”. Foundation trusts had

3440-927: The NHS. It implemented electronic patient record system Lorenzo Release 1.9 in June 2010. In 2013 the Care Quality Commission stated that there had been problems with the Commission's oversight of the trust in 2010, that the Commission had "provided false assurances to the public" and that "[it] should not have registered UHMB without conditions", on publication of a report by Grant Thornton . Jackie Daniel, chief executive said in June 2016 that she hoped to make her hospital "as small as humanly possible" as part of its new care model plans. Emergency and maternity services are to continue in Barrow and Lancaster, but about 65 weekly outpatient clinics will be replaced by community provisions and beds will be reduced. A new chief executive, Aaron Cummins,

3520-473: The National Health System. Therefore, the 2003 law establishes coordination and cooperation of public health authorities as a means to ensure citizens the right to health protection, with the common goal of ensuring equity, quality and social participation National Health System. The law defines a core set of functions common to all of the autonomous health services. Without interfering with the diversity of forms of organization, management and services inherent in

3600-481: The National Institute of Health Management, INGESA. Under Chapter III of the 1978 Spanish Constitution, all Spanish citizens are beneficiaries of public health services. Concretely, it establishes that: Further, the Organic Law 4/2000 ( Ley Orgánica 4/2000 ) establishes the rights and liberties of foreigners resident in Spain. Its effect on the healthcare provision can be seen in the following articles: Article 10 of

3680-542: The Royal Lancaster Infirmary both "required improvement". In February 2015 it was announced that the Clinical Commissioning Groups planned for inpatient elective surgery at Westmorland General Hospital to be transferred to Royal Lancaster Infirmary and Furness General Hospital. The trust decided in October 2015 to contract out its outpatient pharmacy services to a private provider. In 2014/5

3760-490: The Spanish National Health Service ( Consejo Interterritorial del Servicio Nacional de Salud de España ), which has great flexibility in decision making, as well as mechanisms to build consensus and to bring together the parties taking such decisions. A system of inspection, the Alta Inspección , assures that accords are followed. The Royal Decree-Law 16/2012 was introduced on April 20, 2012. It puts into law severe cuts in

3840-652: The Spanish National Health System, including the following: The Ministry of Health and Social Policy develops the policies of the Government of Spain in matters of health, in planning and delivery of services, as well as exercising the purview of the General Administration of the State to assure citizens the right to protection of their health. The ministry has its headquarters on the Paseo del Prado in Madrid , across

3920-471: The administrative document that accredits its holder and provides certain basic data. In order to best facilitate collaboration, quality, and continuity of services, the each card includes a standardized form of basic identification data for the holder, and indicates in which autonomic health service the person is enrolled. In particular, the cards incorporate a digital form of this information; health facilities throughout Spain have appropriate equipment to read

4000-405: The autonomous communities had gradually assumed purview in matters of health and had established stable models to finance the assumed purview. Meanwhile, in the 17 years since the original law, Spanish society had undergone many cultural, technological and socioeconomic changes that affected people's ways of life and affected the country's patterns of disease and illness. These posed new challenges to

4080-522: The beginning of the 19th century, the Balmis Expedition (1803) to administer the smallpox vaccine throughout the Spanish colonies was a public health undertaking of unprecedented geographical scope. The Cortes of Cádiz debated a sanitary code (the Código Sanitario de 1812 ), but nothing was approved due to lack of scientific and technical consensus about the actions to be undertaken. During

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4160-429: The board of directors have no statutory duty towards the governors. The governors cannot, without the board of directors' permission, have any control over the direction of the trust, and cannot appoint or remove trust auditors. The chair and directors are not appointed by their board of governors. Spanish National Health System The Spanish National Health System ( Spanish : Sistema Nacional de Salud , SNS )

4240-419: The centers, services and establishments of the community itself, as well as its deputations, municipal governments, and whatever other territorial administrations fall within that community. The Law of Cohesion establishes the Interterritorial Council (CISNS) as the organ of coordination and cooperation of the SNS. In the autonomous cities of Ceuta and Melilla the corresponding health services are provided by

4320-573: The clinic as well as in the patient's home. Article 13 of the Law of Cohesion regulates characteristics of health care offered in Spain by medical specialists , which is provided at the request of primary care physicians. This may be in-patient hospital care or out-patient consultation at specialist centers or day hospitals . It includes care, diagnosis, therapy, rehabilitation and certain preventive care, as well as health promotion, health education and prevention of illness whose nature makes it appropriate to handle at this level. Specialized care guarantees

4400-527: The clinical history document is sometimes known as a "health history" ( historia de salud ) or "life history" ( historia de vida ). The Clinical History of the [Spanish] National Health System ( Historia Clínica Digital del Sistema Nacional de Salud , HCDSNS) is intended to guarantee citizens and health professionals access to whatever clinical information is relevant for medical care of a particular patient. This history should be available at all authorized locations, but nowhere else: except as needed for treatment,

4480-433: The communities are responsible for health in their respective territories. Each year the CISNS, after deliberation, establishes the portfolio of services covered by the National Health System, which is published by a Royal Decree of the Ministry of Health. Each autonomous community then establishes its respective portfolio of services, which includes at least the service portfolio of the National Health System. Article 42 of

4560-423: The continuity of integrated patient care once the capabilities of primary care have been exhausted and until matters can be returned to that level. Insofar as patient condition allows, specialized care is offered in out-patient consultation and in day hospitals. As of 2010, Spain recognizes fifty distinct medical specialties. Article 14 of the Law of Cohesion defines social-health care ( atención sociosanitaria ) as

4640-537: The council of governors to work towards a merger. A study undertaken in 2005 by the King's Fund of Homerton University Hospital NHS Foundation Trust found some governors disappointed and disillusioned. Another report in 2005, funded by the Nuffield Foundation , found that it was too easy to invite members to sit on sub-committees, where they quickly became bogged down in the minutiae of operational planning, whilst

4720-499: The digital information from the cards. A cardholder should thereby be able to access all the services of all relevant health professionals throughout the country. A patient's clinical history is a medical-legal document that arises from the interactions between health professionals and their clients. From a medical and legal point of view, the clinical history is the only document valid to track this history of interactions. In primary care, where methods of health promotion are important,

4800-588: The end of the Franco regime. Social Security had taken on an increasing number of diseases within its package of services, as well as covering a larger number of individuals and communities. The General Health Law ( Ley General de Sanidad ) of 25 April 1986 and the creation of Health Councils ( Consejerías de Sanidad ) and a Ministry of Health, fulfilled the mandate of the Spanish Constitution of 1978 , in particular Articles 43 and 49 which made protection of health

4880-420: The information is considered confidential and access is restricted. The term "Health Area" ( Área de Salud ) refers to an administrative district that brings together a functional and organizational group of health centers and primary care professionals. A Health Area may be exclusively focused on primary care or may include specialists as well. Some autonomous communities use different term, such as Direction of

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4960-489: The law is the National Health System. The presumption underlying the adopted model is that in each autonomous community, authorities are adequately equipped with necessary territorial perspective, so that the benefits of autonomy do not conflict with the needs of management efficiency. The National Health System is thus conceived as the set of health services of the Autonomous Communities properly coordinated. Thus,

5040-532: The law that established the Spanish National Health System also shifted financing toward progressive general taxes and away from payroll taxes. In a 2000 report, the World Health Organization ranked Spain 26th of 191 countries in its fairness in financing. In 1999, reform to income tax deductions allowed high income earners to deduct more for private insurance. Although this reform was intended to decrease overconsumption of health care services, it had

5120-509: The main decisions were taken at meetings that they only heard about after they took place. The public's perception of foundation trust status implying a high standard of clinical care was changed by the Mid Staffordshire NHS Foundation Trust scandal of the late 2000s ( Stafford Hospital Scandal ) and the ensuing Francis inquiry , published in 2013. At the outset, some critics claimed that foundation trusts went against

5200-434: The market. It has been argued to be the beginning of deregulation. The General Health Law was complemented in 2003 by the Law of Cohesion and Quality of the National Health System ( Ley 16/2003 de cohesión y calidad del Sistema Nacional de Salud ), which maintained the basic lines of the General Health Law, but modified and broadened the articulation of that law to reflect existent social and political reality. By 2003, all of

5280-529: The participation of the autonomous communities. Among these are the Agency of Evaluation of Technologies ( Agencia de Evaluación de Tecnologías , Spanish Agency of Medicines and Medical Devices ( Agencia Española de Medicamentos y Productos Sanitarios ), the Human Resources Committee ( Comisión de Recursos Humanos ), the Committee to Assess Health Research ( Comisión Asesora de Investigación en Salud ),

5360-480: The principal functions of the Interterritorial Council of the SNS. The principal aspects of the Interterritorial Council are: The Interterritorial Council is constituted by the Minister of Health and Consumer Affairs [now of Health and Social Policy], who holds its presidency, and by the Councilors with purview over matters of health of the autonomous communities. The vicepresidency of the body will be fulfilled by one of

5440-533: The private patient income cap but FTs have to do the majority of their work for the NHS. This restriction was kept to reassure those concerned about future developments that FTs would continue to have NHS work as their central concern. Previously each FT had its own cap, set at the level of its private activity when the first FTs were established in 2003/4. About three-quarters of all FTs had a cap of 1.5% or less. Until 2010 all mental health trusts were completely barred from undertaking non-NHS work, but after lobbying from

5520-412: The public sector and less autonomous than was originally expected. By March 2013 there were 145 foundation trusts, of which 41 were mental health trusts and three were ambulance trusts. They included acute trusts, mental health, community and ambulance trusts. By March 2019, the number of foundation trusts had shown a small increase to 151. The basic governance structure and form of foundation trusts

5600-587: The rest of Europe, particularly among the physicians of the Golden age of Jewish culture in Spain . In the years after the Reconquista , the Real Tribunal del Protomedicato regulated the practice of medicine in Spain and in its colonies. However, the system of medical faculties at the various universities was very decentralized. Surgery and pharmacy were quite separate from medicine and were considerably less prestigious;

5680-430: The side effect of more regressive financing of public health services. Nevertheless, that same year payroll taxes were completely phased out while higher indirect taxes (on excise goods such as alcohol and tobacco) were earmarked for health care. Article 57 of the Law of Cohesion establishes that citizens' access to health services will be facilitated by use of an individual health card ( tarjeta sanitaria individual ), as

5760-607: The spirit of the principles laid out by Aneurin Bevan , the founder of the NHS. Others feared that it would lead to a two-tier system. Others doubted whether foundation trust members would succeed in having any effective influence over hospital management. In 2011, some argued in a report financed by the Nuffield Foundation that the success associated with foundation trusts had been due to other factors than governance. In June 2014, Bill Moyes, former Monitor executive chair, urged

5840-599: The street from the Museo del Prado . The Royal Decree 1041/2009 of 29 June lays out the basic organic structure of the Spanish Ministry of Health and Social Policy. From the date of that decree, the new ministry assumed the functions of, and superseded the former Ministry of Health and Consumption ( Ministerio de Sanidad y Consumo ) and Secretary of State for Social Policy, Family, and Attention to Dependency and Disability ( Secretaría de Estado de Política Social, Familia y Atención

5920-466: The supposed autonomy when almost all had to rely on money borrowed from the Department of Health, to which strings were attached. Foundation trusts have some managerial and financial freedom when compared to NHS trusts . The introduction of foundation trusts represented a change in the history of the National Health Service and the way in which hospital services are managed and provided. At

6000-628: The systems of Galen and Hippocrates dominated medical practice during most of the era of the Antiguo Régimen . Medicine was one of the principal fields of activity for the novatores of the late 17th century, but their initiatives were individualized and localized. There is some continuity from their work to the broader work during the Age of Enlightenment , such as through the Colegio de Cirugía de San Carlos ("San Carlos College of Surgery") in Madrid . At

6080-599: The time of introduction, they were described "as a sort of halfway house between the public and private sectors". This form of NHS trust is an important part of the United Kingdom government's programme to create a "patient-led" NHS with an internal market . The stated purpose is to devolve decision-making from a centralised NHS to local communities, in an effort to be more responsive to their needs and wishes. But after Gordon Brown prevented plans by Alan Milburn to make them financially autonomous they have been much more in

6160-572: The trust was given a loan of £21 million by the Department of Health which is supposed to be paid back in five years. It spent 7.2% of its total turnover on agency staff in 2014/5. The trust was taken out of special measures in December 2015 after a further inspection. In August 2014 it was announced that the Trust would make an application to Monitor (NHS) for an increase in the prices paid for treatment by

6240-409: The various health services fall under the responsibility of the respective autonomous communities, but also under basic direction and coordination by the central state. The respective health services of the autonomous communities would gradually realize a transfer of health resources from the central government to the autonomous communities. The law of 1997 allowed private health care companies to enter

6320-588: Was appointed on 1 April 2018, as was Ian Johnson as the new Trust Chair. The trust joined the Waterloo House GP practice in Millom in October 2016 to run the business side of the practice as part of the Better Together vanguard project. The Trust was highlighted by NHS England as having 3 of 148 reported never events in the period from April to September 2013. In December 2013 it was announced that despite

6400-507: Was the Health and Social Care (Community Health and Standards) Act 2003 . The first ten NHS hospitals to become foundation trusts were announced in 2004. Gordon Brown prevented plans by Alan Milburn that they should be financially autonomous in 2002. By 2012, the Monitor website listed 145 foundation trusts. Successive governments set target dates by which all NHS trusts were supposed to have reached foundation status. For example, by 2009

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