Fears are growing that trusts could be shackled by increasing control from the centre as government and regulators attempt to get a tighter grip on performance.
The Foundation Trust Network this week attacked the Healthcare Commission's incoming developmental standards as 'highly centralist' and 'overtly prescriptive' adding that they crowded 'local accountabilities out of the agenda'.
Meanwhile, the commission has criticised the Department of Health for embarking on an approach to efficiency that could lead to 'micro-management'. In a paper discussing how the commission can best measure value, the regulator finds fault with several of the productivity indicators announced by the DoH last month and warns of the dangers of incorporating such metrics in a future inspection regime.
The commission is about to close consultation on the developmental standards against which trusts will be judged on this financial year. The network said the proposals 'better suited the old NHS of monolithic organisations based on command and control from the centre'.
It questioned whether any central body should be defining the development agenda for foundation trusts, warning that the 'overly centralised determination of every [developmental] standard ends up being over prescribed with no flexibility for local determination to be real'.
Network director Sue Slipman told HSJ the standards - designed to set a direction of travel for trusts - belonged to the 'old world of the NHS' and were a 'straitjacket' for setting local priorities with commissioners.
She said the commission should concentrate on core standards, adding: 'Developmental standards are by their very nature about responding to local needs. You cannot set a nationally imposed system.'
The commission has been set a remit by government to introduce developmental standards which this year will cover safety, clinical and cost effectiveness, patient focus and public health. But Ms Slipman said the commission's proposals to achieve this were 'over prescribed'.
Commission chief executive Anna Walker said it believed in 'light-touch regulation' and would listen to the network's concerns. But she stressed that regulators had a role to assess performance of organisations spending public money.
The network made its comments as the commission's board discussed a paper by its strategy department on how it should fulfil its statutory duty to assess value for money.
The paper notes that the DoH 'is keen to see further development of the assessment of productivity' and says value for money should now be put at 'centre stage'.
Last month, the DoH published a list of indicators compiled by the NHS Institute for Innovation and Improvement, to encourage trusts to benchmark performance against national average and best performance.
The commission's paper says the organisation should work with trusts, the institute and the DoH to consider 'how our assessment system might incorporate and support at least some of these'.
But it goes on to outline the 'limitations of these productivity measures', starkly warning that 'the indicators appear to follow past attempts at 'micro-management' rather than being consistent with NHS reforms'.
Ms Walker criticised the DoH for not sharing its plans with the commission until 'late in the day'. She added: 'I would have preferred to have seen them earlier because then the risk of duplicating and using the same scarce resources to do the same thing is reduced.' She said the commission would 'definitely not' include all of the indicators in its inspection regime. Ms Walker acknowleged the burden on trusts would increase 'a little bit' but stressed that the question of value for money 'really matters'.
The DoH insisted the approach was 'not about targets or micromanagement'.