28 November 2003
As the Lords finally bowed to the will of MPs last week and allowed foundation trusts on to the statute book, any cries of joy from the health service would have been muted.
For those that will not be among the first 50 foundation trusts, there would have been some dismay that it will probably be April 2006 before they can gain this status.
And those trusts in the first two waves, expected in April and October next year, will be concerned that they will be subject to an early investigation by the Commission for Healthcare Audit and Inspection, despite the promises of less interference in their work. They will also wish to examine the details of concessions handed out by ministers during eleventh-hour bargaining.
These concessions include new arrangements for membership of foundation trusts and their boards of governors. The minimum number of staff members on the board has been increased from one to three and, where appropriate, Welsh patients using English foundation hospitals will be able to become members.
Health Secretary John Reid also confirmed that foundations may be asked to implement the new NHS pay system, Agenda for Change, not next April but in October – the same time as non-foundation trusts.
The Department of Health, anxious to keep the candidate trusts on board, was due to explain the amendments to potential foundation trusts' chief executives this week and the Chai review will be high on the agenda. Foundation candidates' chief executives will also hope to convince the department that they should implement Agenda for Change in April. Reid also announced that all 32 trusts in the second tranche would go forward to make a formal application this week.
If foundation trusts had fallen, the DoH would have used the meeting to explain how it would extend the responsibilities of three-star trusts using existing legal powers. Instead, officials will ask the 25 candidates for April's first wave to submit their applications by December 12. Successful applicants will be announced in January.
The Chai review will take place between autumn 2004 and autumn 2005 and no new foundation trust applications will be accepted during this period.
Public Finance understands that it could cover all aspects of foundations' governance arrangements and the effect of the trusts on other local health organisations. This could include the impact of their borrowing on capital funds available to neighbouring non-foundation trusts, and whether they affect recruitment and retention of staff in other NHS organisations.
King's Fund chief executive Rabbi Julia Neuberger says the review process should start as soon as possible and run parallel with the development of foundation trusts. 'We would like foundation trusts to be assessed by the five key tests of efficiency, access, quality, accountability and impact on local stakeholders before they are extended to all hospital trusts,' she says. 'This will go some way to ensure that standards are raised across the board and that non-foundation trust hospitals are not left behind. Devolution means a variation, but we believe this is acceptable as long as minimum standards are high and the lessons of improvement by some are quickly learnt and spread to others.'
Despite the last-minute changes, there are probably enough inducements in foundation status to keep the pioneers interested.
NHS Confederation chief executive Gill Morgan says: 'It is now widely acknowledged that the NHS has been prevented from acting sensitively enough to local issues, and foundation trusts represent a step towards tackling this problem. We now need to concentrate our efforts on making the proposal work.' However, she echoes the view held by many in the service that while foundation trusts are an important element of the government's reforms, they are not as important as the reform of funding flows and the Patient Choice initiative.
Meanwhile, foundations' opponents, such as Unison, vowed to fight on against a scheme that they believe will create a two-tier NHS. What with this battle, and the Chai review likely to take place in or around a general election campaign, NHS managers' wishes that the debate should focus on more wide-reaching reforms are unlikely to be heard.
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