On shaky foundations

Much of the debate about foundation hospitals has centred on the
likely creation of a two-tier health service in which the
three-star NHS trusts chosen for the accolade take the lion’s share
of resources. The publication this week of the House of Commons
health committee report on foundation trusts has done nothing to
allay these fears.

A great deal less has been said about the consequences of
foundation hospitals for social care agencies and, in particular,
partnerships with social services. Yet, since the government’s
“vision” of adult social care is that it should serve largely as an
adjunct to the health service, the repercussions of the policy are
likely to be felt well beyond the hospital walls.

In health committee chairperson David Hinchliffe’s gloomy
prediction: “Poorer performing hospitals will see their revenue
streams dry up and will have even less to invest in improving
services, locking them into a downward spiral of poor performance.”
It is impossible to believe that the social services departments
bound to these hapless hospitals by a variety of partnership
agreements would not be dragged into the same spiral.

Milburn may envisage every hospital aspiring to foundation status
within five years. But where is the evidence that this can be
achieved given that seven trusts in every 10 either remained the
same or fell in the star-ratings system between 2001-2? The extra
billions earmarked for the NHS between now and then are unlikely to
bring about the massive changes in management culture and clinical
excellence that would be required to close the gap in such a short
timespan. The result is likely to be partnerships every bit as
variable in performance as the hospitals on which they are

Others may argue that partnerships with primary care trusts will be
the real focus of attention now that they hold 75 per cent of the
NHS budget. But PCTs themselves may well be able to opt for
foundation status in the next two or three years and, in the
meantime, PCTs with foundation hospitals in the neighbourhood will
have to cope with just the same skewed priorities and failures to
work in partnership as their social services colleagues. At the
very least more safeguards for partnerships must be put in place,
if the edifice that was being so carefully assembled is not to

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