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Paul Corrigan: the future of foundation trusts

The biggest clash between NHS culture and strategy continues to be found around foundation trusts.

Their founding legislation was aimed at separating FTs from the Department of Health and the old structures of control in the NHS. When the opposition front bench supported that separation, this route was secured at a political level.

But many in the NHS still act as if this did not happen. “Surely,” they think, “FTs are a part of the hierarchy and so whatever the DH tells the NHS to do, then FTs have to do it too - parliamentary legislation notwithstanding?”

Looking at the coming financial squeeze, these people scan the horizon and see FTs with developed surpluses, thinking this money could be put into the balance sheet, relieving the NHS of the need for several billions in savings that FTs have already carried out.

Someone then disappointingly points out that, because of the legislation, the SHAs and the DH have no control over that money and suddenly the culture sees an opportunity looming out of the financial crisis.

Given the nature of the NHS’s finances, wouldn’t everyone support a change in the legislation that would bring that money back to the NHS? The depth of the crisis must surely drive a change of legislation to bring reality back into line with the fantasy of a single hierarchy.

That’s where many in the NHS hierarchy are now, hoping a reaction to the financial crisis will force us back to the way things were. Surely all it needs is a clause added to the Health Bill?

The mistake in this line of thought is to have not recognised the forces that broke up the culture in 2003 are now stronger than they were then. So any attempt at going backwards will be easy to stop.

Traditional NHS culture, as in 2003, is misreading the powers ranged against it. The next piece of legislation concerning FTs passed by Parliament will extend their powers, not limit them.

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