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Last Updated: Sunday, 19 June 2005, 21:54 GMT 22:54 UK
Building on the foundations
By Nick Triggle
BBC News health reporter

South Yorkshire has become the first 'foundation trust economy'
To all but those in South Yorkshire, the milestone will probably have passed unnoticed.

With the announcement Rotherham General Hospital was to become a foundation trust, the triangle of northern England framed by Barnsley, Sheffield and Doncaster became the first patch in the country to have all its hospitals granted this elite status.

South Yorkshire Strategic Health Authority hailed the decision by regulator Monitor as a reflection of the quality of the hospitals in the area which serves 1.3m people.

But the four trusts - Rotherham, Barnsley, Sheffield and Doncaster and Bassetlaw - are also set to become the test bed for how foundation status could revolutionise the NHS.

Monitor believes having a "foundation trust health economy" will allow the hospitals to become more innovative than foundation trusts that find themselves isolated.

Stephen Humphreys, the regulator's director of communications, said the bunching could lead to greater collaboration between the hospitals as they seek to maximise the freedoms granted to them.

Hospitals given foundation status are not-for-profit organisations which have more freedom from government control
They have the power to set their own priorities, and decide how best to spend their money
They are also able to raise their own funds through the sale of land or assets, and banks loans
Trusts are expected to use all of this extra money to improve patient services. For instance, they can recruit extra staff or build new wards
Critics, however, say foundation trusts will create a two-tier health service

But Mr Humphreys also admitted the so-called economy could lead to hospitals competing against each other to justify their elite status.

"We do not want to see red-blooded competition for competition's sake. It has to be about providing better services for patients."

The trusts remain cautious not to raise expectations too high.

But the group of four, along with Chesterfield Royal Hospital NHS Foundation Trust - a nearby trust which shares patients with the others - and Sheffield Children's Hospital - which is applying for foundation status - have taken one precautionary step.

They have teamed up to recruit someone to explore what can be achieved through working together.

Denise Potter took up the position just a few weeks ago, but already sees the potential to redefine the local health services.

She said: "The traditional district general hospital is changing and I think as foundation trusts we have a real opportunity to collaborate and develop services.

"Patient choice is coming in and we need to respond to that."


Ms Potter said there were no concrete plans as it was still early days, but admitted it was possible some hospitals could see the development of "super-specialities" where cancer services were concentrated on one site.

She also raised the possibility of having a branch of one hospital opened at another in a similar way that businesses franchise.

"Take Sheffield Children's hospital. It is landlocked and can't expand. So why couldn't it open a unit at another hospital and have Sheffield Children's Hospital from such and such?

We can collaborate and that is where you might see a difference
Annette Laban, of the South Yorkshire SHA

"There are also the more obvious options of sharing staff and sharing equipment.

"If we are purchasing an MRI scanner we could consider a mobile one so we could share it between hospitals."

She also said the trusts were considering the possibility of expanding into the previously unchartered territory of providing primary care services by bidding for contracts to cover out-of-hours GP care.

And she did not rule out the possibility of running their own GP surgeries.

Sue Slipman, director of the Foundation Trust Network, an arm of the NHS Confederation, also believes the hospitals may be able to benefit from a better relationship with the local primary care trusts which purchase the services on behalf of patients.


Doncaster and Bassetlaw NHS Foundation Trust was the first of the trusts to be granted foundation status in April last year, so Ms Slipman believes many of the PCTs will have already developed an expertise in dealing with foundation hospitals which often require more urgent decisions and commitments.

"The real advantage it will give them is that the PCTs will be used to dealing with foundation trusts.

"If a foundation trust is in an isolated environment they can find a lack of understanding about their requirements."

But Annette Laban, a director at South Yorkshire SHA, which was responsible for overseeing the trusts until they were granted foundation status, warned having such a group could work in the opposite way than expected.

"The government wants to see all hospitals get foundation status so I suppose we will be looked at for an early indication of what might happen.

"I think it is swings and roundabouts really. If you are a foundation trust on your own you can get competitive advantages from the freedoms you get.

"Our trusts won't have that, but of course we can collaborate and that is where you might see a difference."

Hospitals seek foundation status
26 Jul 04 |  England
Q&A: Foundation trusts
07 May 03 |  Health

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