Shut off the foundation trust pipeline

For the great majority of NHS trusts, achieving foundation status is a potentially damaging distraction.

Former health secretary Alan Milburn last week called for all trusts to be given foundation status and for the NHS Trust Development Authority to be merged with Monitor. His inclinations are correct, but his tactics are poor.

‘The merger of Monitor and the TDA would also be classic NHS displacement activity’

FT status is largely about winning the right to relatively limited freedom of action. This is important – and few FTs would surrender it – however, it pales into insignificance compared to the radical service reconfiguration required to make the provider sector fit for purpose. The focus of most non-FTs needs to be on the difficult choices this demands and not on jumping through regulatory hoops, electing governors or reconstituting their finances.

Run dry

The merger of Monitor and the TDA would also be classic NHS displacement activity; plunging the sector into a debate over organisational form and role, leadership and - of course - some very significant redundancy packages. Both organisations have plenty to do and, assuming they can carry on working well together, they should be left to get on with their jobs.

The FT pipeline has almost run dry. Only a handful of authorisations are expected in the next 12 months. The pragmatic and appropriate new strategy adopted by Monitor illustrates it is focused on helping the sector cope with change rather than aggressively pursuing the “all-FT health economy” that was the goal of previous policymakers.

‘The government should announce that no more FT applications will be processed after June’

The current health secretary recognises that increasing the number of FTs comes low on the list of the services’ priorities and that the model may not be appropriate for all providers.

For the sake of clarity for patients, staff and stakeholders and to ensure that the focus of non-FTs and regulators alike is where it should be, the government should announce that no more FT applications will be processed after June. This will need careful communication, especially where organisations have linked their corporate reputation to achieving FT status, but most would welcome the chance to concentrate on the real challenges.

A review of appropriate governance models and regulatory oversight for providers should then be carried out by the next government within 12 months of it taking office.