By Nick Mann | 15 December 2011
Ministers’ plan for all NHS hospitals in England to become foundation trusts by 2014 is a ‘very tall order’, MPs said today.
In a report on the progress trusts are making towards attaining the self-governing status, the Commons’ Public Accounts Committee found that the challenges were ‘more severe than previously thought’.
Currently 139 trusts have foundation status. The 113 remaining have set out their progress plans in formal agreements signed with the Department of Health and their strategic health authority.
However, four out of five said financial difficulties could be a barrier to them achieving foundation status, the MPs found. Many also identified performance, governance and strategic obstacles.
Twenty declared they were ‘unviable’ and would not make foundation trust status in their present circumstances. Half of these are located in London.
Others would have to reconfigure or even merge services to meet the government’s aspirations.
PAC chair Margaret Hodge said: ‘This may deal with the financial challenges involved but could leave some deprived communities with unequal access to high-quality health care, when hospital departments are closed and services moved.’
The committee raised particular concerns over London, where at least half of the hospital trusts were not viable in their current form.
Hodge added: ‘London is in a particularly shocking state and nobody has got a grip on long-standing problems. We remain to be convinced that combining struggling hospitals into larger trusts – as with south London – will somehow produce viable organisations offering good quality, accessible health care.’
With only 14 hospital trusts having achieved foundation status since the end of 2009, the PAC said strong leadership was ‘urgently needed’ to ensure those trying to make the change were able to do so. In particular, it said that decisions on changes to services needed to be taken ‘promptly but wisely’.
Trusts were also urged to demonstrate how any mergers they had to make would create health care benefits for local communities and to ensure these changes did not reduce access to services for vulnerable people. This, MPs said, could increase health inequalities.
Sue Slipman, chief executive of the Foundation Trust Network, said the report showed the need for public involvement in the changes being made by hospitals trying to become foundation trusts.
‘We are glad the PAC recognises the need for honesty in public discussions to change existing services to meet longer term patient need,’ she said.
‘We would have wished for a clearer recognition from the PAC of the implications of delay in making the necessary changes to those organisations which are currently successful, or will be so in future.
‘We hope this report leads to greater political support for the now obvious case for such changes to be rapidly implemented. If not, currently successful organisations could be pushed to the brink of failure.’
NHS Confederation deputy chief executive David Stout added: ‘We urgently need a proper framework for dealing with failing trusts and a clear process for consulting and enacting major reconfigurations. We need politicians to look at this thorny issue as a priority and produce a clear plan for the next two years.
‘Time is running out and we cannot afford to find ourselves in a situation where trusts go bust and care standards slip. It is essential that these issues do not continue to drift.’
