'Having strengthened their financial management without comprising service quality, foundation trusts are now in a position to step up their investment in providing first class patient care'

Foundation trusts were disappointed that the announcement of the recent healthcheck ratings failed to highlight the real achievements that have been made over the last two years. As a result, we believe it obscured one of the success stories of health reform so far.

The healthcheck figures clearly show that foundation trusts as a sector are delivering better care for patients and better value for money.

  • Eighty-four per cent of all foundation trusts were rated as excellent or good on use of resources, compared to 10 per cent of other acute and mental health trusts.

  • Sixty-seven were rated excellent or good on quality compared to 45 per cent of other acute and mental health trusts.
    The two organisations rated excellent on both criteria are both foundation trusts.

The results suggest that having strengthened their financial management without comprising service quality, foundation trusts are now in a position to step up their investment in providing first-class patient care.

The figures also suggest there is a foundation trust journey, with 33 per cent of aspirant foundation trusts achieving excellent or good on use of resources and 59 per cent achieving an excellent or good rating on quality. Once they begin to experience the rigours of the application process and the new financial and governance framework trusts quickly improve.

Monitor's most recent quarterly report was similarly upbeat about how foundation trusts are progressing. It showed they made a strong start to the year, achieving an aggregate net surplus of£17m in the first quarter,£19m above plan. And it highlighted their progress in setting challenging targets for efficiency savings with capital expenditure forecast to increase to£537m in 2006-07 to make that on-going commitment to raising service quality.

With these achievements under their belt, the challenge now is to ensure foundation trusts can continue to flourish. The the sector is faced with growing financial risks from the need to balance the system because of deficits elsewhere and the knock-on impact on commissioners' ability to contract for the real levels of activity required to deliver the 18-week target. (To understand more about the 18-week target, click here)

Destabilising risks

Strategies for system balance are also devastating teaching and training funds, while the failure to align the new research and development strategy with the development of the specialist tariff could result in huge financial shortfalls for even the strongest foundation trusts and pile up the risks they face to a level that could destabilise them.

These risks now need to be addressed, alongside a renewed focus on the roll-out of foundation trust status to create a critical mass of foundation trusts able to drive this next stage of reform.

This is all the more important in the light of the healthcheck results. With 92 per cent of primary care trusts assessed as fair or weak in their use of resources and two-thirds fair or weak on service quality measures, the gap between strengthening provider organisations and PCTs only just emerging from a major reorganisation is stark.This imbalance will derail the NHS reform programme if there is not now a real drive to invest in the development of commissioning across the country. The next operating framework must also restate clear system rules and a code of conduct that is respected by all if we are to find a transition path through this next difficult stage of reform.

So our message to government is clear. If you want system reform to succeed you must focus on two key priorities. Ensure there is support for effective commissioning for the new PCT
And don't inadvertently destabilise foundation trusts by failing to recognise their achievements and the risks posed by fragmented policy initiatives.

They are the emerging flagships of the ability of the public sector to produce good-quality services, better value for money and greater accountability to the communities they serve. ≪

Sue Slipman is director of the Foundation Trust Network.