The foundation trust model must be updated to prevent a hospital centred approach which could “perpetuates silos”, shadow health secretary Andy Burnham has said.

At the Foundation Trust Network’s annual conference Mr Burnham said that while the FT model was the “perfect vehicle” for driving change, there were problems with it which “must be acknowledged and addressed”.

“First, there is a risk that the FT model coupled with the activity tariff has reinforced a hospital dominated model of care,” he said yesterday.

Andy Burnham

There are problems with the FT model that must be addressed, Andy Burnham said

“Second, the FT model and the authorisation regime around it has brought a focus on the viability of institutions rather than of whole health and care systems. It can perpetuate silos rather than breaking them down and encourage organisational competition rather than collaboration.”

He added that the “danger” of the current approach was that, in seeking to remain financially stable, an FT could destabilise other organisations around it.

“This is why the pipeline has clogged and some organisations are not able to find a way through,” Mr Burnham said.

He said a Labour government would move Monitor’s focus from looking at the finances of one organisation to “whole health economies”.

He also said his planned move towards integrated care organisations may result in fewer providers overall. He called for more “flexibility” for organisations to merge to achieve financial viability.

Meanwhile, in his speech to the conference yesterday, FTN chief executive Chris Hopson called on next year’s new government to take an “adult to adult” approach to NHS organisations, with intervention replaced by support.

He said there was currently a “fragmented” and “increasingly interventionist” regulatory regime taking the NHS “back to the centrally driven micro-management that this government promised they would abandon four years ago”.

Change should be led at a local level, with providers acting as the “catalysts”, he said.

Mr Hopson added: “There is much suspicion in the rest of the NHS about the idea of big, bad, burly providers leading change in their local communities.

“There is a suspicion that we will shore up our own activity levels, our own finances and our own success at others’ expense… That suspicion is misplaced… If we are to catalyse, drive and enable the transformational change that is now required, we can only do so if we build a shared, collaborative leadership model.”