Elite NHS trusts 'lack ambition'

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The government's flagship policy to set hospitals in England free of central control has failed to live up to expectations, MPs say.

The Commons' Health Committee said foundation trusts were not showing enough vision or providing the extra services they were expected to do.

But the MPs said they were not helped by local health bosses who were not committing funds to such projects.

Foundation trusts said they were now in talks about making more progress.

The foundation trust model was created in England in 2004 to encourage the best-performing NHS trusts to become more imaginative.

Scotland, Wales or Northern Ireland have not followed suit.

We are pleased that evidence shows foundation trusts are performing well financially Kevin Barron, Health Committee chairman

So far over 100 trusts - half of hospitals and half of mental health trusts - have been given the status by the regulator, Monitor.

This has granted them the freedom to borrow money, while at the same time facing only light-touch regulation and no requirement to balance the books year-on-year as other parts of the health service have to.

But the MPs said these freedoms had not translated into new ways of working.

The report said the elite trusts had done little to move care away from hospitals and into the community, such as setting up consultant clinics, or setting more ambitious waiting time targets.

Instead, they have amassed surpluses and failed to make the most of their ability to borrow private money.

Untouched

On last count, foundation trusts had £1.5bn of surpluses as well as leaving £900m worth of overdraft facilities largely untouched.

But despite their financial freedoms, the MPs also said they needed greater support from local health bosses working for primary care trusts, which are responsible for commissioning services.

And they added the government should set up a "systematic and independent" review of foundation trusts to find out what else may be preventing progress.

A report from the NHS watchdog the Healthcare Commission this week rated the overwhelming majority of foundation trusts excellent on both financial management and quality of services.

However it was only able to judge them on what they were doing, not what they could be doing as the MPs have.

Health Committee chairman Kevin Barron said: "We are pleased that evidence shows foundation trusts are performing well financially."

But he added he wanted to see more innovation and greater public involvement which after all were "two key aims when foundation trusts were established".

"Foundation trusts could be doing more, but at the same time they need PCTs to be commissioning these extra services. For some reason this is not happening."

Sue Slipman, of the Foundation Trust Network, said: "Many trusts have ambitious plans, but a lot of commissioners have not got their act together.

"There are talks happening about this and I think in the future we will see progress."