comment Foundation trusts and Healthcare Commission will usher in new era

Published: 01/04/2004, Volume II4, No. 5899 Page 17

Another April. Another new era. The fact that the first foundation trusts and the Healthcare Commission are being launched on the same day is highly appropriate.

The relationship between these two bodies will have an impact on the NHS far beyond the number of trusts that achieve foundation status before the moratorium on new trusts comes into force this October.

During the final years of the dotcom boom it was often said that the impact of new technology was always over-estimated in the short term, but under-estimated in the long term.

That sentiment is very relevant to this latest stage of NHS reform. There will be considerable sound and fury around the arrival of foundation trusts, but in truth their limited number will restrict their influence on the NHS as a whole over the next two years. Likewise the Healthcare Commission will spend most of this year, and a significant part of next, completing work begun by its predecessor, the Commission for Health Improvement.

But it would be a foolish to believe that the NHS has not embarked on a fundamental change in its nature - particularly in its relationship with government.

Through the creation of foundation trusts and an inspectorate with such a broad range of powers, the NHS has taken a big step away from central government control.

If - heaven forbid - the commission discovered a major clinical failure at a foundation trust in the next few days comparable to the Bristol or Alder Hey scandals, it is the regulator who would call the trust to account. The government would be required - by law - to keep its distance, however much the media and opposition cried out for a response.

The desire of government not to be blamed for things it cannot realistically control was a major mover in the creation of foundation trusts as our story on the development of the policy demonstrates (The Big Story, pages 12-13).

Over the last 12 months or so, the government has genuinely been trying to wean itself off command and control. When Walsall Hospitals trust chair Barry Blower was rude about agency nurses, the government saw it as a test of its resolve (news, page 7, 25 March). That resolve was very near breaking point when Mr Blower at last resigned, but the recovering control-addict will need some time to feel comfortable about their new role.

The example set by foundation trusts and the desire of government to stand back should, gradually, begin to give trusts of all kinds greater confidence in determining their own future. This is something they have struggled with - even when encouraged by government - as our foundations analysis also reveals.

This sense of freedom should be enhanced by the work of the Healthcare Commission in reducing the burden that the messy and poorly aligned regulation of the NHS currently places on the service.

Another aspect of freedom from the centre is the increasing relevance of local governance and priorities. The governance arrangements for foundation trusts may have significant inconsistencies and weaknesses, but regulator Bill Moyes takes them very seriously and is clear that he expects governors both to be listened to and to bear their fair share of responsibility in ensuring that trusts deliver the services their communities want.

In determining what those services should be, the regulator will be heavily influenced by the work of the Healthcare Commission, which wants to 'foster the idea' that local priorities matter as much as national targets. Since the performance criteria it develops will have an enormous influence on both, it is in a very powerful position to succeed where the government has yet to make any real impact.

Significantly, both Mr Moyes and commission chair Professor Sir Ian Kennedy want to improve the quality of primary care commissioning.

The NHS will not feel much different today, but in three years' time it will be clear that 1 April 2004 was a watershed in the development of English healthcare.