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sounds like an excuse for a poorly run trust other small DGH's have made foundation status in the past and are run well and around quality for patient care. small DGH with foundation status with a personal touch for the patient sounds ideal and where i would want to go. Large impersonal too big multi-sited Uni trusts such as Imperial and other mammoth london trusts. i would consider my idea of a nightmare to be treated in. when are we going to get people at the top with common sense and drive rather than fancy CVs but have actually achieved nothing. Don't blame a government policy and feel sorry for poor relation trusts, just expect the leaders of the poor relations to get their act together.