'Quantity not quality' claim over Foundation plans

Patricia Hewittís plan to boost the number of hospitals seeking Foundation Status, by permitting two-star acute, specialist and mental health Trusts to apply, has raised questions over the rate of reform, fuelling claims of a 'quantity not quality' approach.

The Department of Health (DoH) stated emphatically that "there is no question of lowering the bar and relaxing standards for authorisation as an NHS Foundation Trust", yet described the former three-star requirement as "too restrictive". Hewitt said that she was simply "broadening the base for applicants".

In 2006, the Healthcare Commission will take up the mantle regarding hospital performance ratings, which is the reason, in part, for the DoHís decision ñÜas a preparation for the revised system, which will see conventional star-ratings disappear.

Hewitt announced a second proposal simultaneously, to introduce a new financial diagnostic tool that will be rolled out to help all NHS acute Trusts improve their financial management and assess their suitability to seek Foundation Status.

Behind this plan are "concerns about financial management in some parts of the NHS", Hewitt admitted, noting also that she wanted Trusts ñÜwhether two-star or three-star ñ to be clear on where improvements could be made, in order to gain a more footloose Foundation future.

It could be argued, however, that the pace of change indicates that the government is worried about missing its target to see all NHS Trust hospitals acquire Foundation Status in little more than two yearís time. Currently only 32 out of a possible 290 Trusts have achieved such a promotion.

"Theyíre lowering the threshold, thereís no doubt in my mind about that," commented Ray Rowden, former special adviser to the government and healthcare policy analyst.

"From Blairís perspective, you could argue that extra funding is coming into the NHS between now and 2010 and, as a two- or three-star Trust, youíre either going to be up for the challenge, or youíre not. If you are, youíll do well. If youíre not, other players may come in, which may include privateers or other Foundation Trusts."

For NHS managers, it may be a case of ëdeliver and youíll get a very nice lifeí, Rowden added, noting that despite the robustness and usefulness of the new financial diagnostic tool, "it still sounds like a high risk ñÜthese [Foundation] bodies have a lot of substantial freedoms," he said, pointing to the serious financial trouble that Bradford Foundation Trust incurred last year.

It is understood, from a source close to the situation, that several Labour backbenchers believe government to have set such a fast pace of significant change that it will ultimately fail. Some suspect that this will enable the Prime Minister to call for a new debate with the British Public about whether a rigid funding system based on general taxation is the best way to provide a health system in the UK.

Britain is insular in the EU in the way in which it funds its NHS, with most other countries, both established and newly acceded Member States, choosing a more mixed economy model. Together with international economic pressures, from the international monetary fund and world banks, a flimsy Foundation system could work well in the short term, but also provide a platform for bigger change down the line.

"Some believe that the plan will cause destabilisation and create confusion over elite, Foundation NHS provision, ultimately setting it up to fail, and then open up a different debate with the public about a radical rethink of the very foundation of healthcare in this country," said the source. "Thereís a bigger picture hereÖ if the UK is seen to be the only player [in Europe] with a wholly social welfare model, where does it fit in the macro economic picture?"