Philip Hunt On foundation freedoms

Published: 11/11/2004, Volume II4, No. 5931 Page 21

After a difficult conception, foundation trusts are beginning to reap some rewards from their dash for freedom. Their recent victory in the battle to retain payment-by-results surpluses is a significant straw in the wind. It should come as no surprise to students of ministerial pronouncements.

A clear message coming through at the Labour Party conference in Brighton and repeated time and time again by ministers is that they really are serious about devolution to front-line services.

Health secretary John Reid spelled out the implications of this in a re-ordering of his own job. So, rather than the traditional micromanagement beloved of so many politicians, he sees his role more as a custodian of the founding principles of the NHS. In future, the focus will be on providing the money, overseeing strategic direction and improving public health. To underline this, Mr Reid has just told parliament that foundation trusts are independent of the Department of Health.

In stressing their dual accountability to their local community and to parliament, he said that ministers would no longer be in a position to comment on, or provide information about, the detail of operational management in foundation trusts.

Crucially, he confirmed that such questions will be referred to the chair of each trust.

This produced a predictably negative response from strong opponents of foundation trusts. But the logic is inescapable. If ministers no longer have power of direction over foundation trusts, they can hardly be called on to account for their performance.

Of course this will be tested. There will often be calls for ministers to intervene in a local troublespot. Understandably, foundation trusts are nervous about how much room they are going to be given. But the key to this largely rests with them.

Their strength lies in local accountability. But many have achieved disappointing membership figures.Without a large membership, foundation trusts cannot claim real local legitimacy.

They also have to show that their elected governing bodies have real clout. The practice of some trusts in calling them membership councils is not a positive sign. It seems to downgrade that body into more of an advisory role. Foundation trusts will also have to wake up to closer parliamentary scrutiny. If ministers are stepping back, it is inevitable that MPs will want to see more of the trusts directly.

Chairs will be advised to respond smartly to information requests.

Whatever the debates about funding freedoms and access to capital that so characterised the early arguments about foundations, in the end they will stand or fall on the quality of their services and accountability to their local community.

Lord Hunt is chair of the National Patient Safety Agency and a former junior health minister.