Published: 07/10/2004, Volume II4, No. 5926 Page 9

Trusts will be landed in 'real trouble' if they fail to meet core inspection standards, the Healthcare Commission has warned.

Achieving the core standards will be part of an organisation's 'fundamental licence to operate', chief executive Anna Walker said - although she did not specify exactly what penalties a trust failing to hit them should expect.

She told a fringe meeting of the Labour Party conference last week: 'What the Department of Health is saying - and we would agree - is that these core standards in the NHS are fundamental. People have to be abiding by these core standards. They are something which [comprise] the fundamental licence to operate'. She added that the trusts would be in 'real trouble' if these standards were breached.

She suggested the standards, which were published in July, took a more rounded view of healthcare than their predecessor targets, which will end after next summer.

'We are looking to assess the whole activity of a healthcare organisation, ' she argued.

'I think that the targets we have for the past few years have tended to look at parts of the system but not the whole.'

As well as publishing core standards, the DoH has published a range of developmental standards to which services should aspire.

Ms Walker said the commission will publish the criteria by which performance will be judged for consultation in November.

But she said the new assessment systems, which she hopes will speak more to clinicians and patients, would not mean the death of targets.

'I would not want to mislead you that there will be no further targets - that is not the case, ' said Ms Walker.

As well as monitoring the national targets on waiting and public health already set up by government, the commission is also expected to have a role assessing locally agreed targets, she said.

Withdrawal symptom: from target-setter to 'custodian' The health secretary will become a 'custodian of the NHS'and 'provider of finances'as the devolution of the service progresses, health secretary John Reid has promised.

Mr Reid told a fringe meeting he expected to introduce one or two more targets, but to move away from a 'micro-managed'approach to service delivery.

He said: 'It is not my intention to replace every target as it is made, with a new target. I will introduce one or two new targets, but gradually centrally driven targets will give way to a different system of driving the NHS in its quality.

'You will increasingly see the role of the centre is not to micro-manage the NHS, but to put in place a number of mechanisms where my role is limited.What I want to see the secretary of state do after this is to be the custodian of the founding principles of the NHS... and to be provider of the finances.'

He said the health secretary should 'oversee the strategic direction of the NHS'and improve public health, so that there would be 'powerful weapons at the centre - but the micromanagement will be placed down to the localities'.