University Hospitals Coventry & Warwickshire

UHCW Foundation Trust Project Public Consultation Report

University Hospitals Coventry & Warwickshire NHS Trust

Foundation Trust Project

Public Consultation Report

Contents

 Background and approach  Summary of the proposal and consultation methodology  Activities completed  Analysis methodology  Number and profile of responders  Summary of responses  Conclusions  Details of any changes to the proposals  Communicating the outcome  Next steps, timings, implementation

 Appendix 1 – Proposed constitution  Appendix 2 - Consultation document  Appendix 3 – Display list  Appendix 4 – Communications and Engagement log  Appendix 5 - Consultation responses  Appendix 6 – Amended constitution

whitej6 Page 1 23/12/09 UHCW Foundation Trust Project Public Consultation Report

Background and Approach

University Hospitals Coventry and Warwickshire is applying to become an NHS Foundation Trust (FT).

The Trust had previously started an FT application, including a membership recruitment campaign and consultation preparation but had withdrawn its application in 2006.

In early 2009, the Trust began a new application and, it is as part of this that the Trust has conducted the statutory public consultation covered by this report.

The approach to the consultation was determined early in the planning process and was approved by the Strategic Health Authority (SHA). The plan, publicity materials, consultation questions, analysis methodology and consultation dates were also approved by the SHA.

Decisions were taken to:

 Start anew and not revisit the previous membership and consultation results. This was due to the length of time that had elapsed, making previous data and information of dubious value, and concerns around using information that was 3 years out of date to contact members, who had probably not heard anything from the Trust in 3 years or so.  Run a general awareness campaign (internally and externally) in the run up to and in parallel with the consultation and membership recruitment campaign.  Make use of as many existing opportunities as possible to meet with stakeholders and the public, as well as setting up specific consultation activities.  Run the initial membership recruitment campaign in parallel with the consultation, not starting recruiting public members until the consultation was launched. This meant we could give members something (the consultation) to be involved in right from the very start of their membership.  Communicate widely and intensively with staff about our FT application and their staff membership, prior to the consultation, so they were well informed and able to knowledgably get others involved in the consultation.  Keep the Staff Side of the JNCC briefed and well informed in the weeks and months running up to the consultation.

Also, during the planning phase, the Trust consulted stakeholders on their perceptions of the Trust, as part of the vision and strategy development, and to help the Trust identify a range of initiatives and success measures to contribute to the 5 year Integrated Business Plan. The resulting Strategy/Vision awareness sessions were also used to highlight the FT consultation.

Because of this, the consultation was taking place in an environment of comprehensive awareness and a growing understanding of the future direction and strategy, supported by consistent and cohesive messages. Given this approach, other activities conducted before or in parallel with the consultation and which, though were not directly part of it, underpinned and facilitated it, will be covered to some extent in this report and appear in the Communications and Engagement log (Appendix 4).

Summary of proposal and consultation methodology

Proposal

University Hospitals Coventry and Warwickshire (UHCW) NHS Trust is aiming to provide excellent patient care through learning and discovery and so to be the best choice for people in Coventry, Warwickshire and beyond.

The Trust, which manages University Hospital in Coventry and the Hospital of St Cross in Rugby, is proposing to become an NHS Foundation Trust, believing that this is the best way to fulfil the exciting plans for the hospital, its patients and staff. It also believes it is the best way for many people with an interest in health services to become involved in influencing them.

The consultation was not about whether the Trust should be applying to become an NHS Foundation Trust but about the strategic aspects of the Trust and the way it would operate as an FT, particularly around its constitution and governance arrangements. It was not on operational details or what the Trust would actually do.

Certain key, but non-statutory elements of the proposed constitution (Appendix 1) were the focus of the consultation, concentrating around the proposals for the Trust’s future name and identity, its membership (minimum age and constituencies), arrangements for and numbers of governors and arrangements for the Board of Directors.

 The minimum age for members  The subdivision of the constituencies  The Trusts proposed name and identity  The number of governors  The proposals for governors from partner organisations  The arrangements for the Board of Directors  The transitional arrangements

Feedback on any other aspects of the Trust’s plans were welcomed, whether directly or indirectly associated with the FT application, and these were fed into the appropriate channels within the Trust (e.g. the Patient Experience and Expectations Group and the Trust’s Communications Committee).

Consultation Methodology

The recently developed Trust strategy/vision/objectives, identity and FT membership recruitment campaign were launched at the same time as the consultation and this allowed for a single publicity campaign covering all these aspects. Any opportunities focussing on a single aspect were used to bring in the other aspects and widen coverage, at little extra cost or effort, wherever possible.

The FT consultation and membership campaign sat under the “Your Health, Your Trust, Your Say” banner, branded within the Trust’s new identity. This meant that promotional materials served both purposes and single design, print and production runs covered both. This led to significant economies of scale and the ability to carry out extensive awareness raising activity without excessive cost. It also allowed for comprehensive and coherent messaging using a wide variety of channels and media and saved time and effort both for presenters and audiences. This allowed us to reach a wider range and more audiences than would have otherwise been possible.

Because membership forms were provided along with consultation documentation and visa versa (Appendix 2), analysis of our membership during the consultation period allowed us to measure, to some extent, our reach into “hard to reach” groups. We then did some targeted activities in the latter stages of the consultation period (e.g. Asian Carers’ Forum, young people at North Warwickshire College, the unemployed at a CSWP job fair) to ensure wide and representative coverage.

The consultation document (Appendix 2), supported by information and additional materials on web-sites, in presentations and other communications materials, outlined what an FT is and why the Trust thinks this is the right move for all. It also provided information about membership and governors and how being an FT would work at the Trust.

To reach as wide an audience as possible, the information was made available in different languages and formats, in hard copy and on the web site as both downloadable documents and an eBook, supported by extensive and regularly updated Questions and Answers and presentations. Hard copies were put on display at numerous sites across the Trust (Appendix 3), supported by posters, exhibition stands and information on plasma screens and ticker displays. For internal audiences, articles appeared regularly in the staff newsletter; InTouch and all staff email was used.

A consultation feedback form was provided with a pre-addressed, freepost facility for its return. An on-line facility for submitting responses was also made available. This not only facilitated focused feedback via responses to specific questions, it also allowed additional comments and feedback via free text. Separate letter and email correspondence and even telephone calls to the FT office were also welcomed.

The consultation ran for a 12 week period, from the 17th of September to the 9th December 2009 inclusive.

At meetings and presentations during the consultation period, all questions and verbal feedback were recorded so they could be fed into the consultation analysis. Key stakeholder organisations’ formal responses were requested in writing, either by way of their meeting minutes or separate letter/email.

All members who responded to the consultation were sent acknowledgement letters and, up to the last week of the consultation, these also asked them to encourage others (family and friends) to participate.

Activities completed

An initial campaign plan was produced, identifying and serving as a guide to the activities that we wished to cover.

However, as the consultation commenced, some activities in the original plan were not completed, for a variety of reasons, many of which were outside our control (timing of meetings and events, over-full agendas, meetings being postponed or re-arranged, stakeholders not taking up our invitations or simply being unwilling or unable to participate). Where possible, additional events were organised to compensate. Many unplanned activities were completed, as all additional requests for participation and invitations to present/speak to groups or to send materials were met. These additional activities more than outweighed those not completed.

As described previously, targeted activities were added in the latter stages to address any particular shortfalls.

Details of all the activities and follow up actions both in the run up to and during the consultation were logged (Appendix 4). This log also includes lists of the voluntary sector organisations contacted and the Annual Report Mailing list that was used. It will continue to record and monitor post consultation communication of the outcomes, and activities as membership recruitment and governor and membership engagement continues.

As part of the stakeholder analysis conducted during consultation planning, we divided our stakeholders into a number of categories, each having its own particular communications channels and set of consultation activities identified (see table on following page). Sub-sets of these categories had particular activities identified to ensure adequate coverage (e.g. young people, carers, unemployed, BME groups).

Existing stakeholder mailing lists (e.g. the Trust’s Annual Report mailing list) were used to send out the consultation document with an invitation to participate in the consultation.

Stakeholder Direct Channels Indirect Channels Public  Public meetings  Media coverage (press and  Drop in sessions radio) – notices, adverts and  Local Authority Ward Forums articles  Letter/email and consultation  Public transport poster campaign document to all public members (buses and trains) (registered manually up to 12th  Sporting events (marathon, ice November and electronically up hockey match, rugby match) to 1st December)  Social gatherings (fire work  Face to face encounters displays, health fairs, job fairs,  Floor-walkers handing out University Freshers’ event, local consultation documents to colleges) patients and visitors  Displays with materials across  Posters and documentation for both Trust sites display sent to all public  Information on other libraries, GP and dental organisations’ notice boards, surgeries and to all podiatry, web-sites and intranets, articles physiotherapy, osteopath and in newsletters and via their staff optometry/optician practices letters etc. across Warwickshire – all  Information in incidental received a follow up call half publications way through the consultation  Publicity at sporting venues (e.g. period to see if they needed top side board on Ice Arena) up supplies Staff  Letter with pay slips  Intranet content  All staff emails  In Touch newsletter  Staff drop in sessions  Team Briefings  Staff leaflet  Chat with the Chief sessions  Individual meetings and  Presentations to and meetings correspondence with divisions, directorates,  Induction (new staff) departments and staff groups  Posters  Other public channels (as above)

Elected  Pre-consultation letter to all  Meetings with individual MPs members Warwickshire MPs  Other public channels (as listed  Letter and consultation above) document to Councillors  Presentations at Local Authority (County, City/Town/Borough) Ward Forums Trade Unions  Pre-consultation briefings  Pre-consultation sight of and (monthly) to Staff Side via consultation and communications Professional JNCC materials Groups &  Meetings with individual staff  Individual meetings with Trade Bodies side members, as requested Union representatives, as  Consultation meeting with Staff requested Side chair  Consultation materials sent to  JNCC meeting on last day of professional bodies/groups consultation  Other public channels (as listed  Presentations to professional above) bodies/groups (e.g. GP Forums, LMC, Dieticians, Pharmacists)

Key Presentations to and meetings with:  Individual meetings between Stakeholder  PCTs UHCW Chief Executive and Organisations  Neighbouring NHS Boards CEOs of key local authorities and  Partner Universities’ Governing universities Bodies  CVOne/Chamber of Commerce (via Image Working group)  CSW Partnership Board  Coventry New Deal Community Key  Letter to UHCW Patients Forum  Information on other Stakeholder members organisation’s intranets and in Committees  Letter and consultation their newsletters and Groups document to all groups  Information sent out to their staff (Community, Faith, special individually interest) on the Trust’s  Posters on display on their sites communications mailing lists  Other public channels (as listed (e.g. Annual Report circulation above) list)

Presentations to and meetings with:  2 local authority Overview and Scrutiny Committees  Local Medical Committee  Community Engagement Forum  Friends of St Cross  Rugby Forum  Coventry Youth Council  Coventry Equality & Access Advisory Group  Coventry & Warwickshire Voluntary Action Network  Stakeholder groups (e.g. community groups and associations, residents groups, special interest groups.

Analysis methodology

All the feedback from the consultation was analysed, looking at both the content and the weight of opinion of the responses. An analysis of both the numbers of responses against emerging common themes and then the application of weighting factors, to account for level of influence of respondents, degree of representation (individual responses or on behalf of a particular body or group), applicability, legality, practicality and impact (good or bad, for the Trust or for service users and/or our public) was applied.

A number of internal meetings, involving senior members of the Trust (senior managers and execs, the FT Project team and FT Steering Committee etc.) looked at our analysis before making decisions on changes that we will now build into the refresh of our constitution and plans.

Number and profile of responses

The detail of the responses received and their origins are listed in the consultation returns document (Appendix 5).

 99 responses from individuals via the on-line submission or postage pre-paid form were received.  1 individual responded via letter to the Trust.  2 individuals responded via a letters to the local press – 1 being supportive and 1 unsupportive.  Responses have been received from across the County and from a wide range of respondents.  From the identifiable formal responses received from public members we can be assured that we have covered a range of ages, ethnic backgrounds, gender etc.

Both Coventry and Warwickshire Overview and Scrutiny Committees were attended and both have responded with letters of support, including one writing directly to the SHA also.

7 public meetings were held across our 8 constituencies (the 3 Coventry constituencies were covered by 2 meetings).

 Coventry x 2  Nuneaton & Bedworth  Hinckley  Leamington Spa  Coleshill  Rugby

These were held at different times of the day and in a variety of local venues (community centres, town halls, sporting venues).

Despite this and publishing details on the internet, publicity through local and hospital radio and placing public notices in the local press, followed by quarter page full-colour adverts the week before each meeting, 4 meetings attracted no audience. An additional public drop-in session, that was widely publicised via a full 4 page wrap around in the local press, was held at the Hospital of St Cross to compensate.

These meetings generated some feedback directly associated with the FT application but most also included discussion around non-FT matters or had individuals wanting to express their opposition to (or in some instances support for) FTs in general.

The Trust also had a presence, mostly as full formal presentations and question and answers sessions, at 14 Ward Forums during the consultation period. Attendances ranged from 12 to over 50 but all elicited informed discussion, feedback and suggestions.

All 5 local NHS Boards attended and all were supportive of the Trust’s FT application. These were:  NHS Coventry  NHS Warwickshire  Coventry & Warwickshire Partnership NHS Trust  South Warwickshire Hospital NHS Trust  George Eliot Hospital NHS Trust

In addition a Board to Board was held with NHS Coventry and both PCTs have issued letters of support.

Presentations were made to our partner University governing bodies, who also were supportive of the Trust’s FT application. The Local Medical Committee had a presentation too.

All the local parliamentary MPs were written to prior to the consultation and two Coventry MPs visited during the consultation period and went on public record (including in the local press) supporting the FT application. The third Coventry MP responded with no issues and is due to visit us in Janaury 2010. No specific issues with the Trust’s proposals have been raised by MPs.

Other bodies that have been broadly supportive of our application but had particular issues and feed back for us included:  Coventry Youth Council – appropriateness of having a minimum age of 16 for governors and not having young person’s governor  Coventry Voluntary Action Network – not having governor representation from the voluntary sector  Asian Carers’ Forum – not having a carer on the Assembly of Governors  Friends of St Cross – opposed to using opt-out for staff (and volunteer) members, alongside the clause to exclude those eligible for staff membership from opting out and then becoming public members instead  Staff side of JNCC – there should be at least 5 staff governors (or 4 plus a governor seat for the Trade Unions)  Community Engagement Forum – people with learning disabilities should be represented on the Assembly of Governors  Coventry Disability and Access Reference Group – there must be support for members with special needs to access materials and attend meetings/member events  NHS Coventry/Coventry City Council Young People’s Directorate – there should be a young person’s governor (Coventry City Children’s Champion)

Detail of all the responses can be found in the consultation responses tables (Appendix 5).

In all the meetings with and presentations to staff, there has been extensive questioning about what being an FT will mean for staff, the services we offer and the governance arrangements. These have been answered via email, letters, presentations, drop in sessions, FAQs and a staff leaflet. There has been no negative feedback or any specific issues raised by staff that suggest a change to the proposals is necessary.

Summary of responses

After setting aside for separate consideration all responses not directly associated with the FT application, the remaining responses fall into three broad categories:

 Those where either all questions were answered yes or all were answered no and where no addition free text comments or suggestions were submitted.  Those, which covered factors entirely outside the Trust’s control or, those which for statutory or other significant reasons (contrary to national standards, guidance etc.), could not be taken forward for consideration.  Those which could be considered by the Trust.

Those falling into the first category have been included in the analysis of the raw data, as it would be presumptive to believe they simply represented individuals who were entirely in favour of, or opposed to, all the proposals as a matter of principle. However, as they tend to cancel each other out, they proved of little help in assessing the depth of support, or otherwise, for specific proposals or in formulating alternatives.

Those falling into the second category were essentially about the need for, or principle of, NHS Foundation Trusts per se. They also were about having to have members and/or governors as a necessary requirement for becoming an FT and questioned the need for elections for governors separate from the existing election processes for local authorities. As can be seen from the data in Appendix 5, the basis for much of the opposition was the necessary increase in administrative costs associated with maintaining and supporting a membership and assembly of governors.

Those falling into the latter category covered a wide range of issues, with both supportive and unsupportive responses often cancelling each other out. For example, some respondents felt 16 was too young to be member and others thought the minimum age of 16 should be lowered.

On the number of and arrangements for governors, there were many differing suggestions:  Increasing the number of staff governors to meet TU guidance on what an FT should look like  Increasing the number of staff governors in line with the staff ratios in each staff class, to ensure proportional representation  Having an appointed governor from the Trade Unions

 Having an appointed governor from Rugby Town Council (UHCW provides DGH services to Rugby as well as Coventry and Coventry City Council have an appointed governor)  Having an appointed governor representing the voluntary service provider sector  Having a young people’s governor (must be under a specified age) to be elected by the whole of the public constituency  As above but being elected only by public members under the specified age  Having an appointed governor representing young people (possibly Coventry Council Children’s Champion or Chair of Coventry Youth Council)  Having an additional governor/s for North Warwickshire/ Nuneaton & Bedworth/ Stratford & Warwick  Reducing the number of governors for Coventry by one and allocating that governor seat to one of the above  The provision for governors’ expenses in the constitution should say that the Trust “will”, not “may”, pay expenses  Governors should be paid for their time

On the arrangements for Membership, there were many differing suggestions:  Withdrawing the opt-out for staff membership  Volunteers not being automatically made staff members  Volunteers not being eligible for staff membership at all  Dropping the requirement for the equivalent of a minimum 12 month contract/service for staff membership, to allow more staff to be staff members  Dropping the provision that prevents someone eligible for staff membership from becoming a public member should they opt-out of staff membership  Not restricting membership to just England  Lowering the minimum age of 16 to encourage young people to have a say and conversely, raising the minimum age, as 16 is too young to be involved in such important decision making processes  Aligning the minimum age to whatever is the current age of majority  Members’ expenses should be paid

On the arrangements for elections, suggestions included:  Aligning the proposed constituency boundaries (in Coventry) to the parliamentary constituency boundaries  Holding elections alongside, and with, local authority elections, to save on effort cost and public confusion  As above but alongside and with other neighbouring FTs  Lengthening the term of office of governors (perhaps to align to the parliamentary term) so elections can be held less frequently, reducing costs and giving governors longer to settle into their role and be productive

A number of these suggestions could not be adopted either because they would not be lawful under the 2006 Health Act provisions for Foundation Trusts, they would not be acceptable to Monitor or they would not be practical/affordable.

Conclusions

The consultation showed that there is overarching support for the Trust’s FT application and its proposals around its name & identity, membership, governors & board arrangements and transition arrangements.

All the issues raised that are not directly associated with the FT application are being handled separately through the Trust’s appropriate channels.

A number of the issues raised that are directly associated with the FT application cannot be addressed in the ways suggested because they would not be legal or acceptable to Monitor. Examples of these include:

 Combining our governor elections with those of other Foundation Trusts  Holding our governor elections alongside those of the local authorities  Increasing the number of appointed and staff governors beyond the number of public elected governors

A number of the issues raised that are directly associated with the FT application can be addressed by taking actions other than modifying the proposed constitution and the Trust will take action on these. Examples include:

 Aligning the constituency boundaries (in Coventry) to those of the parliamentary constituencies  Ensuring representation of special interest groups and groups with special needs, through the use of elected governors leading on and representing particular specific interests/groups, rather than allocating specific appointed governor seats  Making sure members and governors are informed, engaged and have influence and publishing information about their involvement  Providing information and materials in accessible formats

One of the outcomes from the consultation is being taken forward as amendment to the proposed constitution. This is the provision that registered volunteers are eligible for staff membership.

There are many other suggestions that do not need such formalisation and these will be taken forward by the Trust.

Details of any changes to the proposals

After consideration by the Trust’s Foundation Trust Steering Committee (including all Trust Board Executive Directors) the following consultation outcomes were considered and decisions taken not to change the constitution.

 A change in the age limit for membership – no change (most respondents agree with the minimum 16 age limit, there are minority competing calls for it to be both raised and lowered, the majority of existing Acute non-children’s hospital FTs have a minimum age limit of 16).  Governor representation for specific interest/single issue groups – no change (there have been many requests for governors from such groups, so which would be deemed valid and which not, and the risk of any single issue dominating the agenda is too great).  The addition of an appointed young person’s governor – no change (this would in essence be a governor place for a specific interest group and so was rejected for the same reasons as the point above. Also, by far the majority of Acute FTs do not have a young person’s governor).  The addition of an appointed governor from Rugby Borough Council – no change (it was felt that there would be adequate representation through Warwickshire County Council’s governor and the two elected governors from Rugby).  Additional elected governors for N. Warwickshire and/or Nuneaton & Bedworth – no change ( it was felt that there would be adequate representation through Warwickhire County Council’s governor and the elected governors from the Warwickshire constituencies).  A provision that expenses will (not may) be paid to governors – No change (the exact provisions for governors will be added to the Trust’s travel and expenses policy).  Governors from Overview and Scrutiny Committees – no change (the OSCs themselves do not support OSC governors on the grounds of potential conflicts of interest and the Trust agrees with this position).  An additional staff governor (potentially from the Trade Unions) – no change (the trade unions already have voice through the staff side of the JNCC).

One consultation finding is being taken forward as a change to the proposed constitution. .  Volunteers should be eligible for public, and not staff, membership – change accepted (this responds to the significant concern from the Friends of St Cross regarding volunteers being made staff members using the automatic membership (opt-out) method of recruitment. It is also in line with the majority of Acute FTs who do not have volunteers as staff members).

The detail of this change regarding the membership of volunteers, is reflected in the amended constitution (8.2). This can be found at Appendix 6 and will be published on the Trust’s web site.

Communicating the outcome

The Trust will be open and transparent about the outcomes of the consultation and will communicate these widely. This will include the rationale for accepting or discounting feedback and information on how feedback not directly related to the FT application was redirected to other appropriate areas for consideration.

A summary of the consultation outcomes and the amended proposals, including an amended constitution, will be published on the Trust’s web site and intranet. A summary will also be included in our first Members’ Newsletter.

Follow up sessions with key stakeholders, Ward Forums and a number of groups, committees and organisations are already planned so we can give feedback at a more detailed level directly. These are included in the log (Appendix 4).

Presentations for both internal; feedback to staff is also a central plank of our strategy, and external audiences will be modified to include the outcomes and reflect the resulting changes.

Any additional requests for feedback on or meetings to discuss the outcomes will be met and we will formally respond to the feedback letters received, not only giving general feedback but addressing specific issues that may have been raised.

Next steps, timings, implementation

The consultation findings and draft report were considered by the Trust’s Foundation Trust Steering Committee on 14th December 2009. Decisions on amendments to the proposed constitution were made at this meeting.

The report and proposed constitution was then modified and amended versions will go to the Trust Board on 18th December and the SHA w/c 21st December. The relevant sections of the Trust’s Integrated Business Plan will be completed and/or amended at this time too.

The amended constitution will be placed on the Trust’s web site.

The outcomes will be published and communicated, as outlined in the previous chapter, starting in early January 2010.

The consultation document will be replaced to reflect completion of the consultation and the agreed new constitution etc. This replacement will be a document that supports membership recruitment by explaining FT status, what it means for the Trust, what membership and having governors means, how that will operate and what the governance arrangements will be following this consultation.

Feedback from the consultation not directly associated with the FT application will be redirected as appropriate during January 2010 and resulting actions will be communicated via the mechanisms in use by the areas/groups to who it was redirected.

Appendix 1 – Proposed constitution

Q:\FT Constitution\ UHCW proposed constitution no tracked changes_FINAL-2009-07-17.doc

Appendix 2 - Consultation document

Q:\FT Consultation\ Q:\FT Consultation\ Consultation & membership Consultation materials & - membershipFINAL VERSIONS\13852 materials - FINAL - UHCW VERSIONS\13852 Membership Form - Foundation 10pp - V07.pdf Trust 16pp Brochure - V04.pdf

Appendix 3 – Display list

Q:\FT Consultation\ Consultation Report\Display list.doc

Appendix 4 – Communications and Engagement log

Q:\FT Consultation\ Consultation Report\Comms & Engagement log - CR copy.xls

Appendix 5 - Consultation responses

Q:\FT Consultation\ Consultation Report\Consultation responses.doc

Appendix 6 – Amended constitution

Q:\FT Constitution\ Constitution - post consultation 2009-12-15.doc

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