Government's plans for foundation hospitals come under attack

NHS foundation hospitals could lead to a two tier health service, with hospitals competing for both patients and staff, critics warned this week.

Details of the proposed foundation hospitals, outlined in the Queen's speech, were unveiled in the House of Commons last week by the health secretary, Alan Milburn. He said there would be “no cap” on the number of hospitals that could become foundation trusts and that locally elected people would help run the hospitals, which would be free of government control.

But opponents of the scheme believe it could bring back competition into the health service, something the Labour government vowed to abolish, and leave poorly performing hospitals struggling to retain staff, attract new resources, and improve their services.

Mr Milburn told MPs that 12hospitals would be part of the first phase of the scheme. Initially, only hospitals with a three star rating could apply for foundation status and they could be up and running by April 2004. The hospitals would be run on a not-for-profit basis, and there would be a “legal lock” to prevent their being privatised.

“There will be no arbitrary cap on the number of foundation hospitals, so the charge that the policy is about creating a two tier health service is simply not correct. This is not elitism; it is localism. It is not privatisation; it is a genuine form of public ownership. It is aimed at getting the best health care for the public by giving more control to the public,” Mr Milburn said. “Our reforms are about giving life to the Labour ideal of common ownership, not resurrecting the corpse of Tory privatisation. Our aim is to bind NHS hospitals ever closer to the communities that they serve. In that way, NHS foundation hospitals will be part of the NHS and will always remain part of the NHS.”

The health secretary said that a “prospectus” on how the new hospitals will operate will be published “in due course.” But he reassured MPs that foundation hospitals would be subject to the same inspection and discipline procedures as other NHS hospitals.

However, Frank Dobson, the former health secretary, attacked the plan and pledged to fight it. “I cannot see how the present proposals will not lead to a two tier health service, with one group of hospitals permanently doing better than the others,” he said. Because the new hospitals would be able to borrow money from private lenders they would be able to attract staff by offering them better conditions, he added.

Although the BMA welcomed the move away from Whitehall bureaucracy, it also had reservations about the scheme. Dr Ian Bogle, chairman of the BMA, said: “Our prime concern must be to avoid creating a two tier service in which patients who live near to foundation hospitals—or are vocal and assertive in pressing to be referred to them—receive better services than those who are treated in other hospitals.”