Less than half of acute and mental health trusts are likely to reach foundation status by 2008, regulator Monitor has said.

It made the prediction while questioning whether the Department of Health and strategic health authorities are doing enough to ensure that action plans drawn up to help trusts achieve foundation standard are delivered.

Ministers have consistently said that all trusts should be ‘in a position to apply’ to become foundation trusts by 2008. But Monitor’s latest board papers warn of ‘a significant back-end loading of applicants for FT status up to and beyond 2008’.

Of around 170 acute trusts, Monitor says it expects ‘around 75’ to reach foundation status by 2008, including current foundations, while ‘up to’ 30 of 53 mental health trusts are expected to achieve the same result. The papers spell out the three main obstacles facing trusts hoping to achieve future foundation trust status:

- the lack of an adequate payment by results tariff for rural trusts;

- the affordability of the private finance initiative under the tariff;

- the inability of ‘a large number of trusts’ to achieve either break-even or surplus.

About half of acute trusts have so far been through a diagnostic assessment process run by Monitor, in conjunction with management consultants McKinsey and SHAs, which is designed to alert trusts to the areas they need to tackle to improve their chances of FT authorisation. The rest are due to finish the process next month.

Monitor is concerned that not enough attention has been paid to helping trusts improve their performance after the assessment.

Its most recent board papers say the regulator ‘remains concerned as to whether the DoH and SHAs had sufficiently well-developed arrangements in place to ensure the effective follow-up of the action plans’.

On 10 April, Mr Moyes raised his concerns with NHS acting chief executive Sir Ian Carruthers and offered Monitor’s services to ‘project-manage’ the delivery of action plans for trusts which have been subject to the diagnostic assessment process.

Mr Moyes said that by doing so, the number of trusts going through the foundations ‘pipeline’ by 2008 could be increased by 20. But the DoH has yet to respond.

A spokesman for Monitor said the concerns were ‘not primarily about money, but about making sure there is sufficient focus and commitment’ on the action plans, particularly given the restructuring of SHAs.

Foundation Trust Network director Sue Slipman said it was time for the DoH to act. ‘As yet there has been no sign from the DoH or the new SHAs on what they intend to do,’ she said.

She called on Sheffield Teaching Hospitals foundation trust chief executive Andrew Cash in his new role as DoH director of provider development to ensure that the new SHAs took the lead on helping trusts enact their plans.

Monitor has today authorised five more foundation trusts, bringing the total up to 40.

- Guy’s and St Thomas’ foundation trust chief executive Dr Sir Jonathan Michael has been appointed chair of the Foundation Trust Network.

Sir Jonathan, who has been chief executive of Guy’s and St Thomas’ for the last six years, replaces Andrew Cash next month.