Foundation independence is on a knife edge

Two weeks ago, in an interview with HSJ, health secretary Andy Burnham highlighted the failure of FTs to balance their looser national accountability with more effective local oversight.

NHS chief executive Sir David Nicholson rammed the point home on Tuesday, telling board chairs local accountability had often been lost.

Now the Francis inquiry into the Mid Staffordshire scandal, which was published today, has exposed the precipice awaiting an FT whose board fails to get a grip on operational performance.

Combine poor local accountability and patchy board performance with contracting finances, the risk of trusts falling into deficit, and several FTs emerging from scandals, and it becomes clear there are near perfect conditions for the incoming government to drastically curtail FTs’ independence.

It is not a question of whether someone will take action on FT governance, but who, when and what.

FTs need to do it to themselves before the new ministerial team does it to them. Proposals accepting the weaknesses of current arrangements backed with hard-edged commitments to deliver rapid improvements are the best hope for avoiding an unravelling of the FT experiment.