Information gathered by HSJ from strategic health authorities has revealed only 47 out of 114 tripartite formal agreements setting out how trusts plan to become foundations have received DH approval so far.

Trusts submitted the detailed plans to SHAs at the end of March, before they were sent on to the DH, which started returning the first signed-off batch at the end of June.

But HSJ’s research shows 59 per cent of plans are still being discussed by the DH, with under two months remaining before the 30 September deadline for them to be signed, returned and published.

• First foundation trust application approved for four months

One chief executive of an aspirant trust said: “I am a little surprised that there are so many outstanding.”

Asked for possible reasons, the chief said: “Every time the Care Quality Commission issues a warning notice of some kind the SHA gets nervous about the pipeline implication.”

Other reasons anecdotally being put forward for the delay are pending reconfigurations and the review of private finance initiatives at 22 trusts. At least two community trusts that have taken on different roles under Transforming Community Services are unsigned.

None of NHS South East Coast’s nine tripartite formal agreements have been signed off. SHA head of business support Sue Eggleton said they were being looked at case by case.

NHS West Midlands board papers from a 26 July meeting say 10 have been signed by the DH, with the remaining eight “subject to further discussion with [the] DH and the trusts”.

In the South West, out of 10 agreements submitted only two – those of Royal United Hospitals Trust in Bath and Northern Devon Hospitals Trust – have been signed.

Of the 26 aspirant London trusts, seven have had their agreements agreed by the DH. Among the 19 with unsigned plans are Imperial College Healthcare Trust – which ended the year with a £40m financial black hole – and Barnet and Chase Farm Hospitals Trust, which is awaiting health secretary Andrew Lansley’s verdict on the Independent Reconfiguration Panel’s assessment of planned service changes.

Six of East of England’s 13 and two of East Midlands’ eight agreements are yet to be signed, including Bedford Hospital Trust and Northampton General Hospital Trust – both of which are affected by a review of acute services in the south East Midlands.