Foundation hospitals: a new direction for NHS reform?

Abstract

The Government's proposals to create new ‘foundation hospitals’ are moving forward rapidly, despite considerable political opposition not least within the Labour Party itself, and deep scepticism about the ideas in many quarters of the National Health Service and the professions. Advocates claim they will lead the way to a new understanding of public services and public ownership, ‘set the NHS free’ from the iron grip of Whitehall control, and make health services more accountable to and responsive to patients and local communities1. Critics argue that the ideas are, at best, a half-baked, reheated version of NHS trusts launched in the early 1990s2. At worst, they assert, foundation hospitals are the start of the break-up of the NHS, a creeping form of privatization that will undermine the fundamental values of social solidarity, care according to clinical need rather than ability to pay, and equity in healthcare provision on which the NHS was founded. Although the necessary legislation has yet to be passed, the Government has already issued a prospectus for potential applicants for foundation status, and set out a timetable that would see the first foundation hospital identified this year and coming into being in April 20043. This paper examines the case for foundation hospitals, and tries to set it in the wider context of health policy development and NHS reform over the past two decades. It argues that there is a need for a fundamental change in the systems for governance and accountability in the NHS and examines how the creation of foundation hospitals might help to meet that need.