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Wednesday, 22 May, 2002, 14:38 GMT 15:38 UK
Ministers to free top NHS trusts
Surgery team at work in hospital
Hospitals will be free of Whitehall control
At least four top-performing NHS trusts look set to be given complete freedom to decide how they work.

Hospitals in Cambridge, Northumbria, Peterborough, and Norfolk are to apply to join the first-wave of NHS foundation hospitals.

If successful, the trusts will be independent of government control and will be able to decide their own financial and clinical priorities.
Foundation hospitals
Northumbria Healthcare NHS Trust
Peterborough Hospitals NHS Trust
Norfolk and Norwich University Hospital NHS Trust
Addenbrooke's NHS Trust

They are based on models which have proved successful in Denmark, Spain and Sweden and will come into operation in 2003.

Speaking to NHS managers in London, Health Secretary Alan Milburn said other hospitals will be able to apply to become foundation trusts when guidance is published in July.

The policy aims to give trusts independence within the NHS and act as an incentive for other hospitals to improve their performance.

Three stars

The foundation hospitals, which need to have received three-star ratings in the Department of Health's annual performance tables, will be run as not-for-profit organisations.

They will also be able to opt-out of government targets and demands.

The trusts will be given the freedom to reward staff with bonuses and sell off land to raise money to improve patient services.

The hospitals will be accountable to their local communities and not the Department of Health.

Local council leaders, business and patient representatives will have a say in how the trusts move forward.

Mr Milburn described the move as a fundamental change in the way the NHS is organised.

It frees us up from all of the bureaucracy of Whitehall

Sue Page, Northumbria NHS Trust
"They will help create a radically different health service, that is true to its values but has changed its structures - and one which learns the lessons from what has worked elsewhere in Europe.

"This is a fundamental change. Not in how the NHS is funded or the values on which it is founded, but in how it is organised."

The government is currently working on a legal model for the new type of hospitals.

Successful hospitals will start operating as shadow NHS foundation trusts next April and, subject to legislation, will become fully operational before the end of 2003.

Sue Page, chief executive of Northumbria Trust, welcomed the move saying it would help her hospitals to improve services to patients.

She told BBC News: "It frees us up from all of the bureaucracy of Whitehall. It enables us to take all of our own decisions locally and that means better delivery to the patients living in our area."

Malcolm Lowe-Lauri, chief executive of Peterborough Trust, said the experience of hospitals in other European countries showed the policy worked.

"The advice from people who have gone into foundation trusts elsewhere is that the balance of this is worth doing," he said.

Managers' criticism

However, the measures have been criticised by health service managers.

Dr Gill Morgan, chief executive of the NHS Confederation, which represents managers, said more hospitals needed to benefit.

We will want to work with the government to ensure that we don't create a two tier system

Dr Ian Bogle, BMA
She told BBC News: "It should be extended to far more hospitals.

"It could well be that it remains with a small number of hospitals for quite some time, and that could actually prove a disincentive for other hospitals to improve."

Unions were also cautious. Dr Ian Bogle, chairman of the British Medical Association, said: "We will want to work with the government to ensure that we don't create a two tier system of foundation hospitals and second division hospitals, some of which are locked into a downward spiral, and where patients are left without the quality of care they deserve."

Beverly Malone, general secretary of the Royal College of Nursing, added: "Although the RCN welcomes the government's move towards decentralisation, we are concerned that creating hospitals freed of government control could in the long run undermine the basic principles of the NHS."

Unison, the UK's largest health union, welcomed the extra freedom but warned it could create a "poor relation" within the NHS.

Karen Jennings, its national secretary for health, said: "The government needs to raise standards across the whole of the NHS.

"Instead of setting hospital against hospital, they need to foster a climate of co-operation, so that best practice is shared across the NHS for the benefit of all."

The BBC's Niall Dickson
"This could be divisive"
See also:

15 Jan 02 | Health
25 Sep 01 | NHS Performance 2001
25 Sep 01 | NHS Performance 2001
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