Stronger safeguards are needed to protect partnership working
between the NHS, primary care trusts and councils to prevent
foundation hospitals failing groups such as those with mental
health problems, an influential parliamentary committee has warned,
writes Sally Gillen.
In its report on foundation hospitals, the first of which will
begin operating next April, the health select committee says it is
“strongly supportive” of the development of
But it adds that it is “imperative” the trusts do
not lead to a shift back in favour of acute services, and that
people with chronic illnesses, such as those with mental health
problems who are often treated in community-based care settings,
are not marginalised.
They argue that, while three-star hospitals will be the first to
gain foundation status, winning greater financial freedoms and less
control from the department of health, poorer-performing hospitals
may be starved of cash and become worse. A debate on the issue was
due to take place in the House of Commons on Wednesday.
Committee chairperson David Hinchliffe said he had heard no
evidence to reassure him that foundation trusts would not
“entrench inequalities still further”, adding that the
worst hospitals would become “locked into a spiral of
There are also concerns that those hospitals that win foundation
status may not have increased power to develop locally driven
targets, which could mean they are unable to direct greater
resources towards, for example, children’s health improvement
through Sure Start.
The report recommends that the government should clarify whether
foundation trusts will have fewer national targets.
Health secretary Alan Milburn envisages that every acute
hospital will become a foundation trust within five years.
Mental health trusts are prevented from bidding for foundation
status because their ratings system is relatively new and not
well-developed, but the report urges the government to extend the
status to mental health trusts as a “matter of
Primary care trusts are also excluded from applying because they
are too young and, according to Milburn, need to “develop
their ability to commission”.