Board members are being replaced and organisational autonomy is at risk at trusts lagging behind in the drive to reach foundation trust status.

A document obtained by HSJ shows that one in six trusts in the foundation pipeline have missed or are at risk of missing key targets within months of them being set. The government hopes all trusts will become FTs by April 2014.

All non-foundation trusts had to sign a tripartite formal agreement with the Department of Health and their strategic health authority by 30 September last year. This set a deadline by which their application must be submitted to the department.

But within three months of the signing of the agreements, 18 of the 116 trusts had missed the submission deadline or were considered at risk of doing so.

The information is in a report by Matthew Kershaw, director of provider delivery at the DH. It names three large teaching hospitals that had to delay their  submission date: Coventry and Warwickshire, Leicester and Croydon. Mr Kershaw proposes they take “additional support [which] means a loss of autonomy for the organisation and implications for board leadership”.

University Hospitals Leicester said it wouldn’t comment on the document, Covenrty and Warwickshire also made no response.

Croydon’s chief executive Nick Hulme took up a new job at Barking, Havering and Redbridge University Hospitals but HSJ understands this was not related to the FT process.

The document, dated 23 December, says the SHAs overseeing North Staffordshire Combined Healthcare Trust and Cambridgeshire community services Trust have “already affected [sic] a change of leadership” and proposed changing the trusts’ application dates. North Staffordshire has appointed a new chair, two directors and two non-executive directors since December.

A spokeswoman for Cambridgeshire said the trust had a chair and three non-executives replaced over the past six months after their terms ended. Its application date was put back to October 2012 for reasons “outside [the trust’s] control” following a delay in the transfer of community services from NHS Peterborough.

Other trusts on the DH “concern” list have also had recent changes of leadership (view table).

Hull and East Yorkshire Hospitals Trust appointed a new chair in December and saw its application date put back a year to January 2013.

Judy Wilson, chief executive of South West London and St George’s Mental Health Trust, went on indefinite sick leave in January and an interim has been appointed for four months. The DH document proposed reviewing the trust’s case in May to see if its application date needs to be changed.

HSJ has identified another four trusts that missed their original application date by three months or more (view table).

Mid Essex Hospital Services Trust originally said its application would be submitted in February. A spokesman said it “notified the SHA in December we want to take a slower pace in finalising our application”. He said the trust was “hopeful” of submitting the application by April 2013.

A senior source in the provider sector said he expected more leadership changes caused by trusts missing targets to become FTs in the near future.

He told HSJ: “The truth is that many of these trusts are finding it impossible to demonstrate long term viability – hence the slippage on their [agreements]. 

 “I do wonder whether performance managing [the agreement] timetables is the right way to do this. The logic is that passing the foundation application test is one way of proving long term viability. However, for some this seems like a futile process, which would be better short circuited by a clear ‘viability test’.”

Managers in Partnership chief executive Jon Restell warned the DH and SHAs against blaming managers for systemic problems. “Organisations are in the pipeline for a reason,” he said. “Given the historic problems of these trusts, it would be wrong to confuse corporate failure in the pipeline with the personal competence of individual managers.

“We are already seeing that the process is chewing up good managers. The NHS Trust Development Authority and SHAs must support these boards and managers. Without it, you might be considered unwise to take on these tough jobs.”

A DH spokeswoman said: “We are supporting trusts which are not achieving all their milestones or have performance issues.”