The financial discipline that comes with foundation status is alone an argument for moving all NHS trusts in that direction. A powerful secondary reason is the greater clarity given to the accountability of board directors.
With just a handful of trusts out of 100-plus non-FTs having submitted applications in the last year, this necessary provider reform is running out of steam just at the time when the NHS needs it to motor.
A good use for some of the NHS surplus would be to use it to lift those organisations with a sustainable future out of the mire
So what to do with those that have not achieved foundation status?
There are a number of trusts – perhaps a third of the non-FTs – where there is no obvious obstacle to moving forward. Many have simply been hanging back, mindful of the effort required and perhaps hedging their bets over a possible change of policy. They should be required to submit applications by the year end.
Those that do not should be reviewed for their suitability as standalone FTs. They should be either given intensive support to move them into the FT application process; merged with another trust to become part of an existing FT or able to apply; or placed on a franchise list, allowing NHS and private organisations to propose alternative solutions.
Integration with community services should be no reason to avoid meeting the foundation trust test.
The greatest problem is posed by those trusts with historic financial problems. A good use for some of the NHS surplus would be to use it to lift those organisations with a sustainable future out of the mire.
Finally, it appears the strategic health authorities have mostly run out of the will and ability to drive the process forward.
The foundation trust sector – with the Department of Health’s backing – should be asked to take over. Completion of the foundation trust journey needs a driving force with credibility and nous. University College London Hospitals Foundation Trust chief executive Sir Robert Naylor would unquestionably fit the bill.
Foundation trust applications run into the ground
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Foundation trusts: new approach needed to unblock the pipeline