The Transparency of Trusts

NHS Foundation Trusts and Information Sharing

Dr. Geoffrey A. Walker

January 2015
CONTENTS

Executive Summary 2
Introduction 3
1. The 3 Point Assessment 3
2. Key Findings and Analysis 4
3. Summary and Conclusion 10
Notes 11
References 12

The Transparency of Trusts Dr.Geoffrey A Walker 2015 1

Executive Summary
The transparency of 146 NHS Trusts in sharing information on the organisation in terms of ‘the perceived
quality of intentionally shared information from a sender’ (Schnackenberg & Tomlinson) was surveyed,
analysed and evaluated between the 1st of September and the 31st December 2014. During this period, a 3
point assessment methodology was utilised to assess and evaluate transparency.

An examination of online transparency revealed that a substantial number of Trusts (19%) appeared to be
failing to meet the legal requirements of the FoI Act (2000) by not providing a publication scheme. Some
Trusts provided online access to a disclosure log of FoI requests (22%) but a substantial majority failed to
provide information in this format (78%). A relatively small number of Trusts could be considered as
transparent in their attempts to share organisational information in an accessible format (20%).

Overall, responses to a FoI request were varied in their nature and they varied in formats where
information was provided. Where there was a failure to provide information, reasons given for inability to
meet the request was questionable in some cases. The administration of FoI requests is a particular area of
concern. There is considerable variation, between Trusts, on the managerial level at which FoI requests
were handled.

It would appear that all Trusts were failing to make Monitor’s ratings on Trust governance and services
visible on their websites.

In the interests of organisational transparency, all Trusts should:

• publish their Publication Scheme online;

• provide online access to a Disclosure Log which details responses to FoI requests;
• provide responses to FoI requests, where appropriate, in a format readily available for further
analysis, for example, in an Excel spreadsheet;
• review how they respond to FoI requests and the level of responsibility within the organisation at
which this is undertaken;
• and, finally, publish, on their homepage, the current Monitor rating for governance and continuity
of services and an explanation of the assessment.

The Transparency of Trusts Dr.Geoffrey A Walker 2015 2

Introduction
The aim of this report is to evaluate the ability of Trusts to share information in a culture of
corporate ‘transparency’. As large organisations, Trusts are encouraged by NHSEngland to be
‘transparent’ in how they manage information. NHSEngland has stated that ‘absolute transparency
is the key to driving improvements in standards of care’. A definition of transparency, however, is
not given in any of the literature published by NHSEngland [1], so, for the purposes of this report,
transparency will be defined as: "the perceived quality of intentionally shared information from a
sender" (Schnackenberg & Tomlinson). As such, information should be subject to a defined
process of openness, communication and accountability which can be monitored and evaluated
for its effectiveness.

As a principle, Trusts have a duty to act visibly, predictably and comprehensibly to promote
participation and accountability. Simply making information available is not sufficient to achieve
transparency. Large amounts of raw information in the public domain may breed opacity rather
than transparency.

Information should be managed and published so that it is:

Relevant and accessible: information should be presented in plain and readily comprehensible
language and formats appropriate for users. It should retain the detail and disaggregation
necessary for analysis, evaluation and participation.

Timely and accurate: information should be made available in sufficient time to permit analysis,
evaluation and engagement by relevant users. Information should be managed so that it is up-to-
date, accurate, and complete.

The survey was undertaken, over a four month period, between the 1st of September and the 31st
December 2014. During this period, a 3 point assessment method was utilised to assess and
evaluate transparency which consisted of:

1. evaluating responses to Freedom of Information (FoI) requests;

2. examining on-line transparency;
3. investigating Monitor governance performance criteria.

The 3 point assessment methodology was designed to allow evaluation of information provided
against criteria of transparency, relevance, accessibility, timeliness and accuracy.

1. The 3 Point Assessment

NHS Foundation Trusts were assessed on three areas:

• On-line transparency
Under the conditions of the FoI Act, NHS Foundation Trusts are obliged to publish a publication scheme.
Some Trust also published a disclosure log of FoI requests. Trusts were assessed as to the production an
online publication scheme and a disclosure log. If both were visible, on their web site, they were given a
rating of ‘transparent’. Some Trusts, however, had taken a further step, in terms of transparency by
publishing the responses to FoI requests online.

 Responses to Freedom of Information (FoI)requests

The Freedom of Information Act (2000) applies to most public authorities and governs access to non-
personal corporate information.
The Transparency of Trusts Dr.Geoffrey A Walker 2015 3
The Act sets out three main provisions which are that public authorities:

1. inform a person making a request whether we hold the information of the description specified in
the request;
2. communicate the information held to the applicant unless an exemption exists;
3. adopt and maintain a publication scheme (information regularly published by the organisation).

The Information Commissioner, responsible for monitoring and enforcing compliance with the Freedom of
Information Act 2000, has drawn up what is called a model publication scheme for all public sector
organisations. The Commissioner has also published a definition document for NHS organisations which
sets out in some detail the minimum expectations.

‘Please could you provide a list of all service contracts awarded for
what and to whom during 2013/2014 including maintenance,
domestic, clinical, administrative, medical, care, consultancy and any
other services?’

 Monitor’s governance and continuity of services performance criteria

As the sector regulator for health services in England, Monitor's job is to make the health sector work
better for patients. It is an executive non-departmental public body, sponsored by the Department of
Health. They rate NHS Foundation Trusts on their past, present and future performance [2]. They also
provide real-time updates on the current status of Trusts’ performance.

Monitor, along with NHSEngland and the NHS Trust Development Authority publishes annual planning
guidance for foundation trusts (Monitor et al 2014). There is a section in this guidance entitled ‘Harnessing
the information revolution and transparency’ (pp.19-20).

The new National Information Board (NIB) brings national health and care organisations together with
clinical leaders, local government and civil society. It has recently published Personalised Health and Care
2020: a Framework for Action which builds on commitments in the Forward View to use data and
technology more effectively to transform outcomes for patients and citizens. It proposes six areas for
action which refer to the disclosure of personal but not organisational information.

2. Key Findings and Analysis

2.1. Publication, Disclosure and Transparency

The survey analysed and evaluated the information shared by Trusts in the FoI publication scheme, how FoI
requests were disclosed to the public and the degree of transparency demonstrated.

2.1.1. Availability of a Publication Scheme

The adoption and maintenance of a publication scheme (information regularly published by the
organisation) is a requirement of the FoI Act (2000). The Information Commissioner’s Office publishes
guidance on the scheme by providing a model available for download on its website (ICO 2013).

The ICO provides clear guidance on how to comply with the publication scheme:

‘You should adopt the scheme and you need not tell the ICO you
have done so. The model scheme is appropriate for all public
authorities so you should not change it. You should also make sure
you publish the information it covers.

You should also produce:

The Transparency of Trusts Dr.Geoffrey A Walker 2015 4

  a guide to information, specifying what information you
publish and how it is available, for example, online or by contacting
you; and
 a schedule of fees, saying what you charge for information.

You should publicise the fact that information is available to the

public under the scheme. You should make sure the model scheme,
guide to information, and schedule of fees are all available on your
website, public notice board, or in any other way you normally
communicate with the public.’

Of the 146 Trusts evaluated, 81% had made their publication scheme accessible on line either as web pages
or PDF files. However, a significant 19% had not met this minimum legal requirement (Figure 1).

Yes 118
No 28

Figure 1: Availability of Publication Scheme (N)

The quality of the information provided varied with some only providing basic details of all information
available while others made sections of their publications available through an accessible webpage. Central
and North West London NHS Foundation Trust, for example, provided an example of good practice. They
divided the scheme into sections with clickable access to documentation in each section as seen in the
screenshot below (Figure 2).

Figure 2: Screenshot of Central and North West London NHS Foundation Trust Publication Scheme
The Transparency of Trusts Dr.Geoffrey A Walker 2015 5
2.1.2. Availability of a Disclosure Log
A disclosure log is a mechanism for sharing responses to FoI requests. Of the Trusts under examination, less
than a quarter (22%) had made disclosures available on line with the majority (78%) not making any
attempt to share information in this way (Figure 3).

Yes 32
No 114

Figure 3: Availability of Disclosure Log (N)

Dudley Group NHS Foundation Trust provided an example of good practice by making all its disclosures
accessible through a clickable webpage (Figure 2).

Figure 4: Screenshot of Dudley Group NHS Foundation Trust Disclosure Log

2.1.3. On-line transparency

Where Trusts were providing accessible publication schemes and disclosure logs, they were considered as
moving towards transparency as defined by Schnackenberg & Tomlinson (2014):

‘the perceived quality of intentionally shared information from a sender’

In this case, Trusts, acting as senders of information, had intentionally shared information and the quality
of this information is perceived as acceptable and accessible by the receiver.

A quarter of Trusts (20%) were considered transparent by this criteria (Figure 5).

The Transparency of Trusts Dr.Geoffrey A Walker 2015 6

 Yes 29
No 117

Figure 5: Evidence of Transparency (N)

2.2. Responses to Freedom of Information (FoI)requests

A request for information was made, by email, to the officer responsible for co-ordinating FoI requests in
each Trust. The question asked was as follows:

‘Please could you provide a list of all service contracts awarded for what and to whom during 2013/2014
including maintenance, domestic, clinical, administrative, medical, care, consultancy and any other
services?’

Requests were made to 146 Trusts. 60% replied within the 20 day period while 40% either did not reply
within the 20 day period or failed to reply (Figure 6).

Yes 87
No 59

Figure 6: Responses to FoI Requests (N)

2.2.3. Classifying Responses to the Request

Responses to the request were classified, in 4 categories, as follows:

1. Unable to process: too expensive to retrieve the required information

Trusts that used Section 12 of the FoI Act to refuse providing the requested information on grounds of cost
were exemplified by this response from Durham and Darlington NHS Foundation Trust:

‘The Trust does not centrally record this information. In order to collate this
information someone would need to manually trawl through thousands of
records.
We are therefore refusing your request for information pursuant to section 12
of the Act on the grounds that we estimate that the cost of complying with the
request would exceed the appropriate limit. The appropriate limit at the
present time is £450.00 which equates to eighteen and a quarter hours of
work by a member of staff at the rate of £25 per hour.’

This response implies that the information requested is held in a non-digital format which begs the
question as to how the Trust monitors and evaluates expenditure if central digital records are not held of
The Transparency of Trusts Dr.Geoffrey A Walker 2015 7
levels of expenditure in any financial year. While it is acknowledged that some Trusts are relatively newly-
formed, the initial step, in combining existing organisations would, normally be to collate levels and
patterns of expenditure.

2. Unable to process: information required not available or held only within departments and not held
centrally
With some Trusts that offered the above response, it was unclear if the information was held in
incompatible hard or soft copy formats: possibly in a combination of both. Where Trusts were an
amalgamation of a number of Hospitals the issue of differing departments creating and storing information
differently is clearly a problematic area. However, Trusts that responded appropriately and effectively often
had invested considerable sums of money in installing new computer networks.

3. Processed: request only partially satisfied

In some cases, Trusts failed to respond fully to the request, for example, by not providing information for
the complete financial year or not covering all services. Others failed to provide details of the contract
awarded or the contractor. Partial responses were queried but not always responded to appropriately or, in
some cases, not responded to at all.

Withholding the details of some contracts was considered, by some Trusts, to be in breach of
confidentiality. However, no request was actually made for negotiated details of individual contracts, so,
any rules or regulations of confidentiality do not apply.

4. Processed: request satisfied and further information provided

Approximately 50% of Trusts responded in full to the request and within the 20 day period allowed by the
FoI Act. Responses were received in various formats: Word, Excel and PDF. Most, but not all, information
was tabulated in these formats. The most useful format is in Excel which allows further detailed analysis in
chart and graphic representations.

A minority of Trusts responded by offering extra information in the form of contract number, date awarded
and started. Some published directly to their online disclosure log and provided the URL for the disclosure.
Detailed responses which included further information tended to be provided by FoI teams that were led
by the legal or financial team.

2.2.4. Trust Administration of FoI Requests

There is considerable variation, between Trusts, on the managerial level at which FoI requests were
handled. In some cases, requests were handled by the financial or legal team and, in others, by the
administrative assistant to the Trust. The level of authority of the FoI officer could have considerable
bearing on how requests are handled internally: a request from a solicitor having greater authority than
that of an administrative assistant.

The question of how FoI offices were staffed and the level of responsibility of officers was raised directly
with the Information Commissioner’s Office which stated that they offered no advice on appropriate
staffing of FoI offices within organisations.

The ICO responded to a query on this, as follows:

‘We do not produce guidance in respect of how a public authority

should structure itself so as to be able to comply with its obligations
under the Freedom of Information Act. This is, in the first instance, a
matter for the public authority.’

The Transparency of Trusts Dr.Geoffrey A Walker 2015 8

2.3. Monitor Governance and Continuity of Services Performance Criteria

2.3.1. Governance
The governance rating is Monitor’s degree of concern about how the trust is run, any steps that are being
taken to investigate this and any other action. The role of these ratings is to indicate when there is a cause
for concern at a trust. A rating of green represents an acceptable level of governance while a red rating
precedes the establishment of a review of systems.

70% of Trusts were rated as green, 11% red with 19% under review (Figure 7).

Green 102
Red 16
Review 28

Figure 7: Governance Rating (N)

There appears to be no correlation [3] between the governance rating and the response to FoI requests.

2.3.2. Continuity of Services

The continuity of services rating is Monitor’s view of the risk that the trust will fail to carry on as a going
concern. A rating of 1 indicates the most serious risk and 4 the least risk. A rating of 2* means the trust has
a risk rating of 2 but its financial position is unlikely to get worse. Only one Trust is currently rated 2*:
University Hospitals Birmingham NHS Foundation Trust.

11% of Trusts were rated at level 1 and 11% were also considered to be level 2. 29% were rated at level 3;
49% at level 4 (Figure 8).

1 16
2 16
3 42
4 72

Figure 8: Continuity of Services Rating (N)

Similar to the governance rating, there appears to be no correlation between the continuity of services
rating and the response to FoI requests.

2.3.3. Governance and Continuity of Services: Information Sharing

In the interests of transparency, Trusts should be sharing the Monitor rating of governance ad continuity of
services on their websites along with an explanation of their current status and any action proposed on
reviewing or adjusting the status. In terms of good practice, this would be best provided on the homepage.

The Transparency of Trusts Dr.Geoffrey A Walker 2015 9

3. Summary and Conclusion
The transparency of 146 NHS Trusts in sharing information on the organisation in terms of the perceived
quality of intentionally shared information from a sender (Schnackenberg & Tomlinson) has been surveyed,
analysed and evaluated.

An examination of online transparency revealed that a number of Trusts appeared to be failing to meet the
requirements of the FoI Act (2000) by not providing a publication scheme. Some Trusts provided online
access to a disclosure log of FoI requests. A relatively small number of Trusts could be considered as
transparent in their attempts to share organisational information.

Responses to the FoI request were varied in their nature and they varied in formats where information was
provided. Where there was a failure to provide information, reasons given for inability to meet the request
was questionable in some cases.

The administration of FoI requests is an area of concern. There is considerable variation, between Trusts,
on the managerial level at which FoI requests were handled.

Trusts are not making Monitor’s ratings on Trust governance and services visible on their websites.

In the interests of organisational transparency, all Trusts should:

 publish their Publication Scheme online;

 provide online access to a Disclosure Log which details responses to FoI requests;
 provide responses to FoI requests, where appropriate, in a format readily available for further
analysis, for example, in an Excel spreadsheet;
 review how they respond to FoI requests and the level of responsibility within the organisation at
which this is undertaken;
 publish, on their homepage, the current Monitor rating for governance and continuity of services
and an explanation of the assessment.

The Transparency of Trusts Dr.Geoffrey A Walker 2015 10

NOTES
1. The closest to a definition of transparency provided by NHSEngland is on the webpage:
http://www.england.nhs.uk/tag/transparency/ which provides a series of quotations on the relevance of
this term to service delivery. A definition of transparency, in terms of organisational information sharing is
not provided.

2. Monitor publishes 2 ratings for each NHS Foundation Trust:

i. The continuity of services rating is Monitor’s view of the risk that the trust will fail to carry on as a going
concern. A rating of 1 indicates the most serious risk and 4 the least risk. A rating of 2* means the trust has
a risk rating of 2 but its financial position is unlikely to get worse.
ii. The governance rating is Monitor’s degree of concern about how the trust is run, any steps that are being
taken to investigate this and any other action. The role of these ratings is to indicate when there is a cause
for concern at a trust.
The ratings do not automatically trigger regulatory action. They prompt Monitor to consider whether a
more detailed investigation is needed. Monitor updates foundation trusts’ ratings each quarter and also in
‘real time’ to reflect any regulatory action taken.

3. In statistical analysis, correlation refers to the degree to which two or more attributes or measurements
on the same group of elements show a tendency to vary together. So, in this case, the level of governance
or continuity of services would be related to the provision of information if a correlation of 0 to +1 is
evident. No such correlation was evident.

The Transparency of Trusts Dr.Geoffrey A Walker 2015 11

References
ICO (2013) Model Publication Scheme Available from: https://ico.org.uk/for-organisations/guide-to-
freedom-of-information/publication-scheme/

Monitor, NHSEngland and NHS Trust Development Authority (2014) Annual planning review 2015/16:
guidance for foundation trusts Available at: https://www.gov.uk/government/publications/annual-
planning-review-201516-guidance-for-foundation-trusts

Schnackenberg, A. &Tomlinson, E., (2014) Organizational Transparency: A New Perspective on Managing

Trust in Organization-Stakeholder Relationships Journal of Management DOI: 10.1177/0149206314525202.
Available at: http://jom.sagepub.com/content/early/recent

The Transparency of Trusts Dr.Geoffrey A Walker 2015 12