One more tweak 'could kill foundations policy'

One more tweak to the government's bill to create foundation hospitals could see the flagship policy abandoned by its original champions, senior government sources have warned.

The comments came as the chairs of two of the most highprofile trusts in the running for foundation status launched an outspoken critique on key aspects of the policy, ahead of the Commons vote on the Health and Social Care Bill next week.

Senior government sources said they were expecting the bill to get through the Commons vote with a 'rocky ride' - and they expected a still more bruising encounter when the bill reaches the House of Lords after summer recess, where it could face further amendments.

And one said it would take 'just one more dilution' by amendment of the freedoms on offer for trusts for leading proponents of the concept to turn their backs on it.

At the NHS Confederation conference, the chairs of University Hospital Birmingham trust and University College London Hospitals trust outlined a string of reservations about the way governance arrangements for foundation hospitals are currently anticipated - and the lack of robust thinking on the matter.

John Charlton, chair of UHB, where Mark Britnell is chief executive, said: 'We are only a matter of months away from foundation trusts and it doesn't seem to me that anybody has thought the governance through.'

He told a workshop: 'I am in favour of foundation trusts essentially to get certain people off our backs.Yes, let's have autonomy, let's have accountability, but for goodness sake do not expect us to have a 5,000-strong membership. That would be an absolute nightmare.'

He said that his trust had developed its own set of arrangements for governance 'and if I could get away with that, we could manage the trust quite nicely'. And he said he was fearful of the 'opportunity costs' of chief executives diverting too much of the energy to public consultation and involvement.

'We have got a huge private finance initiative scheme and I want him [Mr Britnell] concentrating on that. I do not want him spending all his time out recruiting members of the local co-op.'

Ed Mayo, executive director of the New Economics Foundation, and one of the architects of the foundation policy, suggested that trusts which were interested in foundation status purely because of its freedoms should take a pragmatic approach to governance.

'If you see it as a dead weight transaction, if you see it as a quid pro quo for getting the centre off your back, then I would advise you to go for as small and token a membership as you can.'

But he suggested that trusts could make better use of the policy to tie in membership arrangements with wider pools of knowledge like self-help groups.

Earlier, Peter Dixon, chair of UCH, where chief executive Robert Naylor is another keen proponent of the foundation model, said the policy needed to be piloted and he urged the government to slow down the pace at which it is rolled out.

'I would like us to proceed at a slightly more measured pace so we can see what works - and if it doesn't, we can backtrack.'

Pointing out that 'we can't force people to be active citizens', Mr Dixon said he remained concerned that those with an interest in governance might not represent the wider needs of the public.

'We will be choosing between the Hampstead Heath Conservation Society and the local Trotskyists.

The Marsden [Royal Marsden Hospital, London] is worried about animal-rights protesters because of their research... There is a danger of disenfranchising those who do not have sharp elbows.'

In a room containing several chief executives from applicant trusts, Nancy Hallett, chief executive of Homerton University Hospital trust, was the only person to speak categorically in favour of foundation hospitals.

She said the government policy 'is crystallising our thinking' about local involvement in services: 'We are talking about something we were not talking about months ago.'

The Department of Health is due to send foundation applicants a 'source book' in the next few weeks outlining the general principles of governance and detailing different models and sources of information.

llaura. donnelly@emap. com See confederation news, pages 10-13; comment, page 17.