The government says that although foundation trusts will not be subject to performance management by the strategic health authorities, they will be locally accountable and therefore responsive to healthcare needs. Foundation trusts will have members drawn from local residents, patients, and staff, and members will elect at least half the board of governors, who in turn will appoint a board of directors.
However, the bill does not require members to be representative of the local population or answerable to it. Nor does it recognise the problem of recruiting members from among people who are frail, less articulate, or have to travel large distances for specialist services. Effective power will rest with an unelected board of directors whose decisions cannot be vetoed by the governors, let alone the members.7
Moreover, unlike other hospital trusts, foundation trusts will not be required to have patients' forums or patient advocacy services, and such patient bodies will have reduced powers under the new local authority scrutiny system, which gives them only consultative rights at the discretion of the regulator.
Governmental regulatory checks can be applied through the new regulatory body, the Commission for Healthcare Audit and Inspection. However, the commission's recommendations are made to the regulator, who alone will determine whether a reported failing is important. Neither the grounds for this evaluation nor any remedies are laid down in the bill.
Strategic health authorities will have limited input at the foundation trust authorisation stage, and little thereafter. Although the bill requires foundation trusts to cooperate with other NHS bodies, this duty is counterbalanced by their freedoms in relation to the recruitment and retention of staff and to subcontract clinical care to the private sector. Furthermore, they will "not be required to comply with management and operational guidance from the Department of Health" and hence will be under no obligation to cooperate in planning of services for whole regions or even the country.7
The formation of foundation trusts will reduce the role of government to funder of NHS care
The safeguards to ensure that equal care is available to everyone who needs it are insufficient
The regulator, and not local people, will be responsible for deciding which services are provided and where
Foundation trusts will find themselves driven to select patients, treatments, and services on the basis of financial risk rather than healthcare needs