Foundation trusts: is there any way back?

The government is facing a struggle to ensure it can re-introduce foundation trusts to the Health and Social Care (community health and standards) bill when it is due to return to the House of Commons on Wednesday.

Last week, peers in the House of Lords voted to remove it. They also rewrote other parts of the bill - including amendments relating to foundations.

During the last vote on the bill in the Commons, in July, the government's majority was slashed to just 35 MPs.

David Hinchliffe, chair of the Commons health select committee and leading opponent of the policy, told HSJ that the only concessions that would end his fight against the proposal for foundation trusts would be 'if it was pulled'. He said amendments to the bill had 'done nothing to address my grievances'.

Mr Hinchliffe said he had spoken to a number of MPs who voted against foundation trusts, or abstained last time, and they were all planning to do so again.

He said the vote at September's Labour Party conference to reject foundation trusts was likely to increase opposition among Labour MPs. But he expected the vote 'to go down to the wire'.

NHS Confederation policy director Nigel Edwards said Labour MPs were likely to be whipped into line to ensure the government policy was returned to the bill.

But he said he was more concerned that hard-won amendments - such as the ability to keep non-executive directors of foundation trusts in place during their transition stages - should not be lost in compromises during the next stage of the bill's parliamentary progress.

This week, the House of Lords forced more changes on the bill, winning an amendment which means every foundation trust must have a patient forum.

They also agreed the health secretary must not retain the right to appoint the chair and commissioners of the Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection, a point which the government had already verbally agreed when it delegated the responsibility to the NHS Appointments Commission.

And former junior health minister Lord Hunt - a champion of the policy - had two amendments to the bill accepted on Friday (news, page 3, 6 November). These stripped away foundation trust governors' powers to approve the appointment of executive directors, and increased the powers of governors over strategic planning.

Lord Hunt said that if the Commons voted to restore foundation trusts to the bill, he hoped the Lords would respect that decision. But he said it was possible there could be concessions: 'In my experience, there is always a bit of horse-trading in these situations.'