Foundation trust applications have slipped by an average of 11 months and some by as much as three years since last March, HSJ analysis reveals. Both the Labour and Conservative parties have pledged an all-foundation trust future.

The scale of the slippage illustrates the huge challenge facing any new government that sees independent organisations as the model of NHS provision, and raises questions about how they will reach the goal.

Many existing foundation trusts are against “lowering the bar”

Forty-six trusts last year said they hoped to have applied for foundation status by now. Only 12 have done so.

Just five have been authorised, according to analysis of information from nine out of 10 strategic health authority regions.

HSJ compared trusts’ authorisation plans from early 2009 with the most recent planned authorisation date available – using submissions to the Department of Health made either last December or last month. The average slippage is 11.5 months and 17 out of 100 trusts had no planned date.

Advocates of provider reform are calling on a new government to adopt radical ways of reinvigorating the lagging policy.

Proposals include a new national body to push some trusts through the pipeline and enforce alternatives for others, or giving this responsibility to foundation trust regulator Monitor.

There will also be pressure on Monitor to lower its standards so more can be authorised sooner. Many existing foundation trusts are against “lowering the bar” but say Monitor could allow a transition period of lower standards for those that take over failing trusts and therefore take on their liabilities.

A senior SHA source told HSJ another option being considered was the creation of “super chains”, in which successful foundations take over failing trusts even if they are located far away. Another idea is for “hospital systems” to link trusts sharing some management and services, but not formally merging them.

Other ideas include franchising management to a foundation trust or independent providers and other collaborations between NHS and private organisations. Many small trusts are looking at merging with local community services.

But few of these options have practical examples. The current drive for vertical integration is also a barrier to more acute takeovers, HSJ has been told, as trusts look to take over community services instead.

University College London Hospitals Foundation Trust chief executive Sir Robert Naylor said a new body responsible for reforming the provider system separate from NHS leadership would accelerate the process – and allow SHAs to focus attention on commissioners.

Sir Robert said: “We need to get the NHS executive focused on commissioning. Some health authorities have been less active in promoting changes necessary to create clinically viable and financially viable FTs.”

Michael Macdonnell, director of consultancy The 10 Partnership, which works with foundation trusts on strategy, said:  “The scale of the challenge is obviously immense and in some ways it couldn’t have come at a worse time, as more than 20 FTs are themselves looking financially wobbly. The time has come for a pretty radical rethink of how we get to an all FT system pretty quickly.”

Foundation Trust Network director Sue Slipman called for clearer leadership on mergers and acquisitions, and cooperation between the parties involved – such as Monitor, SHAs and the cooperation and competition panel. She said: “If they are not going to align all the bits of permission for transactions, and make it [merger] easier, they will not go ahead.”

King’s Fund chief executive Chris Ham said trusts should be cautious of mergers.

He said: “In each area organisations need to sit in a room and work out the future pattern of services. At that stage they can look at organisational implications whether it is FT, an integrated care organisation or any other kind of integration.”

A spokesman for Monitor said: “Trust boards, working with the SHAs, must ensure they are fully prepared to proceed with their application”.

A spokesman for the DH said: “The 31 March returns to the DH are provisional, pending further review.”

Uncertain future

Trusts with no date for FT application or significant slippage

  • NHS London Ten trusts without a date set – many are considering mergers. Ealing Hospital Trust is planning an integrated care organisation with local PCTs
  • Sandwell and West Birmingham Trust Focused on a £484m private finance initiative scheme
  • East Lancashire Hospitals Trust Will “potentially” apply in 2012. Exploring the benefits of an integrated care organisation or “hospital group” arrangement
  • Southport and Ormskirk Trust Slipped from October 2009 to after 2010, with plans to form an integrated care organisation with NHS Central Lancashire and NHS Sefton
  • Hinchingbrooke Healthcare Trust The SHA is tendering for a franchise to run the trust
  • Buckinghamshire Hospitals Trust Plans to vertically integrate with Community Health Buckinghamshire
  • Oxford Radcliffe Hospitals Trust New chief executive Sir Jonathan Michael said it is “committed to becoming an FT at the earliest opportunity”
  • Winchester and Eastleigh Healthcare Trust May apply in spring 2012, but uncertain
  • Nuffield Orthopaedic Centre Trust The trust initially discounted an application due to a £9m deficit but is now reconsidering with no formal FT plans
  • East Sussex Hospitals Trust Plans to be authorised by the start of 2012-13
  • United Lincolnshire Hospitals Trust Recently changed chief executive
  • North Bristol Trust Has an “agreed timescale” but its new £400m hospital is the priority
  • Hereford Hospitals Trust Application suspended while trust works with council and others on options

Foundation trust applications run into the ground