16 May 2003
The government has lined up a number of concessions on its foundation trust initiative in an attempt to ensure its safe passage.
Following last week's muted rebellion, the Health and Social Care (Community Health and Standards) Bill went into its committee stage on May 13, where it faces amendments from MPs of all parties.
Health ministers have already tabled amendments after concerns were raised by Labour backbenchers and bodies such as the Audit Commission.
Last week, commission chair James Strachan claimed that foundations trusts' ability to appoint their own external auditors would result in lower levels of probity. However, the committee of MPs now scrutinising the Bill will vote on an amendment by health minister John Hutton that aims to ease these fears.
The minister proposes that auditors must be members of at least one of the five professional accountancy bodies in the British Isles, including CIPFA, and must comply with directions made by the new regulator of foundation trusts on accounting standards, procedures and techniques.
Hutton also responded to Labour MPs' concerns that foundation trusts would abandon research and training of staff if they proved to be unprofitable. An amendment insists that all foundations must carry out research and education.
The committee stage should be finished by June 19 and the Department of Health told Public Finance this week that the Bill was on course for royal assent in the autumn. Thirty-two trusts applied to join the first wave. On May 14 it was announced that 29 had passed the first stage of the application process. The second stage involves a detailed examination of the trusts' credentials and includes a financial review undertaken by the department. The first-wave trusts are due to be finalised in September or October.
There is little detail about the new independent regulator in the Bill and the Conservatives will attempt to force the government's hand. The Tories hope to remove the health secretary's unilateral power to appoint the regulator by involving the NHS appointments commission in the process. They also want parliamentary approval to be gained to sack the regulator.
Some MPs and unions are concerned that many trusts could be left behind as only those with three stars are allowed to apply for foundation status.
Last week the Commission for Health Improvement reported that the NHS was getting better. The government also promised £200m to help all trusts become foundations within five years.
But concerns remain over the star-rating system. It has emerged that to meet the government's four-hour Accident & Emergency waiting target, many trusts put special measures in place in the week they knew it was being monitored.
A Department of Health study is said to have found that trusts cancelled operations to free beds and flooded casualty departments with extra staff during the week beginning March 24.
The reports were backed up by a British Medical Association survey, which found that two-thirds of A&E departments in England put special arrangements in place. The BMA said temporary use of medical and nursing agency staff was the most common tactic (56%) followed by staff working double or extended shifts (25%).
Don Mackechnie, chair of the BMA's A&E committee, said: 'I am appalled to see how A&E departments have been forced into taking extraordinary measures for a week-long period just to meet political targets.'
Nigel Edwards, NHS Confederation policy director, said it was unsurprising that managers put the extra resources in during the monitoring week. 'What are people supposed to do when they work in a system that threatens sanctions if they don't deliver and then tells them when they are going to do the assessments? It is time to move away from these tick-box targets to something that reflects the realities for patients and staff,' he added.
Despite this controversy, attention will focus on the foundation hospital debate in Parliament. The prime minister has made it clear to his backbenchers he will listen to amendments and has already made some limited compromises. But will his government have to make more meaningful concessions to get its policy enacted?
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