The evaluation by the Audit Commission and the Healthcare Commission of the progress of NHS reforms is a wake-up call for foundation trust managers.

The report on progress since the publication of the NHS Plan in 2000 says the trusts are failing to take advantage of their autonomy to make innovations in service delivery. They are all high-performers, but there is little evidence they are providing better services than when they were tied to their strategic health authority.

Its criticisms touch a raw nerve in government. Negotiations over the content have been tough, HSJ understands. Perhaps the finding on FTs is not so surprising. After years of dependency, it will take time for managers to develop more entrepreneurial skills and encourage innovation and change among clinical staff. With the threat of a visit from Monitor always hanging over a foundation trust, many will be nervous of taking risks.

But trust executives should see this report as encouragement to push the boundaries. FTs were designed to develop new ways of working which would transform the patient experience. If nothing changes, this courageous experiment in liberating the public sector will have failed.

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