The English National Health Service (NHS) is undergoing a period of unprecedented reform and re-organisation as the Government aims to match the extra investment being poured into the service with step changes in quality, efficiency and responsiveness.

Since 2001, spending on the NHS has risen from £45 billion per year to £76bn this year and £93bn by 2008. There have been some notable improvements in waiting times and the management of cardiac and malignant disease has improved, but productivity is unchanged and the gains that have been realised have been achieved through direct management from the centre.

There is a growing realisation that such an approach is unsustainable in the long term, and unlikely to provide the sort of responsive, caring and high quality service expected by the general public. The Department of Health has also made it clear that it plans to transform the NHS from being a provider to being a commissioner of care.

Hence, the Government has introduced a series of market style incentives to stimulate competition and, it is believed, improvements in care. The measures include extending choice of hospital for patients; introducing a new system of paying providers ("Payment by Results"); strengthening commissioning of care; and encouraging new non-NHS providers to compete to provide NHS funded care.

As part of these changes, all NHS Trusts are expected to become Foundation Trusts, fundamentally different types of NHS organisations accountable to their members, stakeholders and the public. They are mutually owned, not for profit, Public Benefit Corporations. They have Boards of Governors elected by members drawn from the public, patients, carers, staff and other stakeholders. They can raise loans on the commercial market and have much greater freedom than NHS Trusts to set their own strategic direction. Although they are expected to make surpluses over a three year period, they do not have to meet current NHS requirements to balance their books every year.

Foundation Trusts are subject to the same regulatory regime, overseen by the Health Commission, as other public and public providers. However, they are not accountable to or performance managed by the Department of Health but to an arms-length independent regulator, Monitor. Although the Department of Health has to approve any application by an NHS Trust to apply for Foundation status, Monitor makes the final decision based on assessments of financial and management capacity.

The process to become a Foundation Trust is significant. The transformation of operations, financial management, corporate governance and organisational culture is complex. The challenge to aspirant Foundation Trusts is not just one of success in the application process, but also of transforming their organisation to deliver the goals, objectives and outcomes expected of a high performing organisation over the long term.

HLSP, Bentley Jennison and The Campaign Company have developed an integrated and comprehensive programme for aspirant NHS Foundation Trusts to guide them through the FT process and beyond. The programme addresses the four main challenges of the FT process:

1. Strategy and service planning (including market analysis, risk assessment, HR and workforce planning)
2. Financial modelling and sensitivity analysis
3. Public consultation and membership strategy
4. Board development and governance

Each work stream is delivered by dedicated experts and led by a single project manager. Our approach involves seminars, one-to-one meetings, modelling workshops, document and data analysis, financial modelling and hands-on involvement during consultation.

Together, we have now worked with a number of aspirant Wave 3 and 3a Trusts, acted as first wave assessors for Monitor, advised a number of clients on the implications of Payment by Results, organised many Board development programmes including mock Board-to-Board sessions, and worked with over twenty NHS Trusts on their public consultation and membership strategies.

The work requires a huge commitment from each Trust to develop business plans and transform themselves into fit for purpose organisations. Not all are successful and as the programme continues, it is likely that successive waves of applicants will find it increasingly hard to develop credible, affordable plans that convince Monitor that they can operate as free-standing businesses. HLSP is in an excellent position to expand its work in this area and grow its reputation for understanding healthcare.