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Last Updated: Tuesday, 6 May, 2003, 23:02 GMT 00:02 UK
MPs hospitals list at-a-glance

Here are the main points raised by the Commons health select committee in their report on the government's plans for foundation hospitals.

Will the changes get better treatment for foundation hospital patients?

  • Perpetual reform of the NHS is costly, reinforcing the importance of ensuring scrutiny of new changes.

  • If there have to be legal contracts between primary care trusts (PCTs) and foundation trusts, that could bring extra costs.

  • The plans offer potential for foundation trusts to get more funds, but it is right to limit the amount of private work they can do.

  • The idea of "local ownership" of hospitals gets support, but it is crucial the plans do not raise expectations that cannot be met.

    Public involvement

  • Foundation trusts could face extra bureaucracy, especially as they will be accountable to four separate types of organisations.

  • There should be national minimum standards for how many members of the public should be involved in the trusts. Trust membership must be available to disadvantaged groups.

  • Systems for determining the democratic accountability of trusts should not be left completely to individual trusts. That could lead to a system of patient and public involvement that is "fragmented, confusing and inequitable".

  • Clarity is needed on whether trust members can veto proposals by the trust through a referendum.

  • More guidelines are needed on what happens if there are disputes on the trusts' board of governors.

  • Major concerns about different arrangements for patient and public involvement in foundation trusts and in other NHS trusts.

    Implications for the rest of the NHS

  • Clarity is needed on how trusts can show the required support for getting foundation status. There is a risk of either costly and lengthy consultations or a tokenistic "charade" of asking public opinion.

  • Foundation hospitals should be subject to the same performance ratings as the rest of the NHS.

  • Performance ratings should be as "accurate and sophisticated" as possible. The contradiction between stars being used to grant foundation status, but not to take it away, should be addressed.

  • The government is piloting foundation hospitals among the top trusts. But there should be an additional trial where all trusts in an area are made foundation hospitals to test the scheme's long-term viability.


  • There must be a balance of power between primary care trusts, covering family doctors and other primary services, and secondary services like hospitals.

  • Safeguards are needed to ensure foundation trusts do not abuse a monopoly position - either by a cumbersome legal process restricting primary care trusts' flexibility, or by expanding services so much that patients have no viable choice.

  • Care is needed over the potential of foundation trusts to change the distribution of hospital services.

  • Stronger safeguards are needed to protect other parts of the NHS from "staff poaching" by foundation hospitals.

  • More needed to reassure non-foundation trusts that they will not lose out on capital funds because the foundation trusts borrow against the Department of Health's spending limits.

  • Plans need to ensure foundation trusts do not undermine the government's determination to reduce inequality in the NHS.


  • Government hopes for all NHS trusts to have foundation status within four or five years may be "too ambitious". Since the introduction of the star ratings system, 70% of trusts' performance has remained static or fallen.

  • Early foundation trusts will attract more resources, and possibly more and better calibre staff. This may be at the expense of worse performing hospitals.

  • Detailed monitoring needed to assess the impact of reforms and identify problems as they emerge.

  • Government should consider ways of making trusts, including primary care trusts, more democratic, with or without the freedoms of foundation status.

    The BBC's Polly Billington
    "Tony Blair is spending the day selling the message on reforming the NHS"

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