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EDITIONS
Wednesday, 13 November, 2002, 14:25 GMT
Top hospitals set for 'freedom'
Top-rated NHS hospitals could be freed from government control within months.

The Queen's Speech confirmed ministers' plans to introduce legislation to establish so-called foundation trusts in this session of parliament.

The not-for-profit trusts will be allowed to set their own clinical and financial priorities for the first time.


We hope that it will not lead to a two-tier health service

Stuart Marples,
Institute of Healthcare Management
The hospitals will be accountable to their local communities rather than the Department of Health.

Council leaders, business and patient representatives will have a say on how the hospitals are run.

The model is based on similar structures in Denmark, Spain and Sweden.

Three stars

Ministers have said that only those trusts that achieved three stars in the government's recent ratings will be eligible to apply for foundation status.

Successful trusts are expected to be up and running in shadow form by April and to be completely independent by the end of the 2003.

NHS managers and doctors have warned the government that foundation trusts could lead to a two-tier health service.

Dr Gill Morgan, chief executive of the NHS Confederation which represents managers, said: "We believe that Foundations could be one way of releasing hospitals from Whitehall control, and a first step towards a more decentralised NHS.

Addenbrooke's Hospital, Cambridge
Addenbrooke's: Tipped for foundation status
"But they must not distract from the more far-reaching government commitment to a wide ranging programme of deregulation for all hospitals, not just the top 10."

Stuart Marples, chief executive of the Institute of Healthcare Management, added: "The devil will be in the detail, but a cautious welcome has to be given to these proposals.

"We hope that it will not lead to a two tier health service and that spur of achieving foundation status will act as a driving force for trusts wishing to gain the much needed freedoms from central control."

Reaction

Dr Ian Bogle, chairman of the British Medical Association, said: "If foundation trusts are to be allowed greater freedoms of process and administration, but will still be judged on the quality and outcomes of the care they provide, then those laudable freedoms should be available to all hospitals."


They will set trust against trust in a mad scramble to get more money and staff

Dave Prentis, Unison
A spokeswoman for the Royal College of Nursing said: "We have concerns that they could lead to the development of a two-tier system with geographical disparities in both hospital resources and nurse recruitment."

Dave Prentis, general secretary of the Unison public sector union, said: "The elitist foundation hospitals will do nothing to foster a climate of co-operation between trusts where good practice and innovation is being shared.

"Instead, they will set trust against trust in a mad scramble to get more money and staff. They will undermine patient confidence in the NHS and damage the morale of hard-working staff."

Rabbi Julia Neuberger, chief executive of the NHS think tank The King's Fund, said: "Foundation trusts are an experiment worth pursuing.

"But foundation status should not be limited to those trusts with three stars, and it should devolve real power to the local NHS and not just superficial autonomy."

Bed-blocking moves

The Queen's Speech also included proposals to introduce legislation to fine councils if they fail to tackle bed-blocking in hospitals.

Under the plans, local authorities could be fined if they do not find alternative suitable accommodation for patients. Many elderly people are stuck in hospital because of a lack of nursing home places.

But Annie Stevenson, of Help the Aged, warned the proposals were "fraught with potential problems" because of a lack of funds and the damage it could do to local working relationships.

Dr Andrew Dearden of the BMA said: "Charging hefty 'fines' will place an even greater burden on them."

In addition, the government hopes to introduce a Bill to establish the new Commission for Healthcare Audit and Inspection.

This will bring inspectorates like the Commission for Health Improvement and watchdogs like the Audit Commission under one umbrella.


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13 Nov 02 | Health
02 Oct 02 | Health
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