Aspirant foundation trusts with liquidity or debt problems could have their debt restructured, the Department of Health’s head of provider development has said.

Matthew Kershaw told an NHS Confederation audience there would be a restructuring of debt “for individual organisations to achieve the metrics that have been set by Monitor” - if that was the only thing standing between them and a successful application.

He told HSJ after the Foundation Trust Network event that the measure would be first trialled in Southampton University Hospitals Trust.

He stressed that debt restructuring would be applied on a case-by-case basis to trusts in the foundation trust pipeline, rather than the DH designing a process that any aspirant FT could apply for.

Mr Kershaw, who is on secondment from his chief executive role at Salisbury Hospital FT, said the restructuring could be applied to “tens” of organisations trying to reach foundation trust status.

There is not yet any detail on how the debt will be restructured.

One trust with similar liquidity problems to Southampton University Hospitals is Lewisham Healthcare Trust. North West London Hospitals Trust and West Middlesex University Hospital trust, both also in the capital, are awaiting news on SHA-level bailouts of their historic debts.

Mr Kershaw said in his visits to aspirant FTs across England there had been trusts whose clinical strategies were rudimentary.

He told the FTN audience: “I am surprised that clinical strategies are not as advanced as they should be in some places”, saying they were the starting point for deciding what the organisation’s function was and that services needed to be designed outwards from it.

Mr Kershaw was responding to a question from an aspirant FT chair who asked if Monitor and the department’s assessment process were, and had been, too focused on finance at the expense of quality.

FTN chief executive Sue Slipman said this had been the case at the start of the FT process.

She said: “Seven years ago you had three stars for quality and that was it. Something got lost in the process and then you had Mid Staffs. I think the ball probably got dropped for a while.

“It [was] something about Monitor’s style and culture. It’s not about blame, they had to bring financial discipline to a system that had none, where it had been run on bungs.”

Toby Lambert, Monitor’s director of policy, said the authorisation process had included improved quality measures for applicants since August 2010 and two organisations had already been turned down on this basis.