A new battle over foundation trusts is set to begin in parliament next month, with the opposition expected to attack proposals they say would rob the organisations of their autonomy.
In response to the Mid Staffordshire foundation trust scandal, health secretary Andy Burnham put forward proposals which would allow ministers to ask regulator Monitor to intervene and strip a trust of its status as a foundation.
The Conservatives have vowed to fight the plans which, if they remain intact, will be introduced to the Commons in the health bill on 12 October.
Foundations fear that making the health secretary accountable would be the first step towards the Department of Health, strategic health authorities and commissioners directing them, for example, to allow staff to work elsewhere, or even pressure them into taking over failing trusts.
A consultation on the proposals ended on Friday and, despite requests for urgent clarification, the government has so far stuck by them.
This week a senior source close to prime minister Gordon Brown told HSJ it recognised the tone of the proposals was wrong, but did not think it would be helpful to withdraw them now. He added that the government planned to clarify its position in its response to the de-authorisation consultation, which is due to be published shortly after the conference season.
The proposals face growing opposition from Monitor – whose response to the plans accuses the government of seeking to “subvert” foundation trust legislation – and Labour supporters of foundations, which have been a key plank of the party’s NHS reform.
Former health secretary Patricia Hewitt, who was considered a strong supporter of autonomy, told HSJ: “I share the concern about what the department is proposing and I have discussed the issue with Andy Burnham, and I have no doubt at all that he is committed to foundation trusts and their autonomy.
“He is seeking to respond to the situation that arose at Mid Staffordshire,” she said. “I understand there are further discussions [going on] between him, the department, Monitor and foundations. I hope an agreement will be reached that does respect their independence and is satisfactory.”
London School of Economics professor of social policy Julian Le Grand, who was involved in developing the policy as an advisor to former prime minister Tony Blair, said it appeared to be the first attempt by the government to re-centralise control.
He said: “There is always an issue about the civil service trying to reassert control…but this is the first serious threat emerging from the government itself. A foundation trust should be accountable to its commissioner [not the government]. If that is being interpreted differently this might be a return [to central control].”
Foundation Trust Network director Sue Slipman said: “We think the consultation is totally flawed and it suggests quite wide scale intervention powers which would be inappropriate for ministers.”
Chesterfield Royal Hospital foundation trust chair Richard Gregory added: “Monitor and foundations trusts’ reaction to the proposals reflects the anxiety in the system about whether the reform agenda is as strong as it was.”
Speaking at a Foundation Trust Network event last week, shadow health secretary Andrew Lansley, described the proposals as “wholly unacceptable”. He said: “[They] would effectively mean there would have to be, alongside Monitor, a completely separate departmental structure, [to decide if] an FT has reached the point where the secretary of state should ask Monitor to intervene.”
In its official reponse to the consutlstion, Monitor says the proposals “are much too broadly drawn, allowing for a significant use of de-authorisation and raising the possibility of significant interference by the secretary of state in the decision-making of Monitor, and the autonomy of foundation trusts”.
However, Mr Burnham was expected to emphasise the government’s ongoing commitment to foundations in a speech to the King’s Fund on Thursday.
the DH said: “We have always said we want to ensure that the changes being considered to the FT regulatory regime maintain the independence of Monitor and foundation trusts.”
*An independent inquiry into care at Mid Staffordshire was launched on Tuesday. Chair Robert Francis QC said he would look at individual patient cases and speak to staff and management about why failures happened.
|Government de-authorisation proposals:|
|Enable Monitor to de-authorise an FT subject to agreement of the health secretary|
|Enable the health secretary to request Monitor take specific action to intervene in or de-authorise a foundation trust where there is “demonstrable poor quality, demonstrable poor governance, or a failure in leadership”|
|If Monitor decides not to act on the request, it would have to “fully justify” this in a public report|
|“The secretary of state is ultimately always accountable to Parliament for the overall provision of NHS services. It is right that the public and members of Parliament look to him to become involved in NHS issues of substantial public concern, such as when a foundation trust is shown to have failed”|