Hospitals that want to cut the strings that tie them to Whitehall and become NHS Foundation Trusts face a tough challenge. The route to autonomy is only open, at the moment, to the 48 acute trusts awarded a three star rating in the recent performance assessment. They have until November to produce evidence of high standards of clinical care and demonstrate sound governance, a commitment to developing staff, high quality leadership, a responsiveness to patients and effective working with local organizations. They will then have to convince a panel, which will include outside experts, that they can go delivering improvements, The successful trusts will be shortlisted and those awarded foundation status will become operational in April 2004.The new foundation trusts will have the option of establishing themselves as not-for-profit companies. They will become more accountable to local communities rather than to national government. Ministers will lose the power to direct trusts and they will no longer be involved in appointing their Board members. The thinking behind this earned automomy is that it should help to unleash public sector enterpreneurialism and innovation.
The NHS is pioneering the Government’s overall public service strategy of moving responsibility away from Whitehall to those who are actually delivering services. The strategy involves finding the best performing organizational units and allowing them to operate with greater freedom. Local government is following closely behind the health service. A system of comprehensive performance assessment is being developed and assessment criteria is being trialled by ten pathfinder councils. The intention is to classify councils into probably four categories. The top, or three star, category will then be eligible to demonstrate that they have earned autonomy and should be given the freedoms on offer. If earned autonomy proves a success it will be extended to a wide range of public service