NHS foundation trusts

Greater autonomy may prove illusory

The rudiments of the government's current strategy for the NHS are set out in the white paper Delivering the NHS Plan.1 This contains a commitment to maintaining a general tax based system, universally available and free at the point of use, and also sets out an ambitious agenda for supply side reform. A central component of this agenda is the creation of a whole raft of new institutions designed to set, monitor, and ensure national service standards—for example, the newly created Commission for Healthcare Audit and Inspection. At the same time, selected local organisations are to be given greater freedom and devolution of decision making power. This is referred to as a process of earned autonomy. The concept of earned autonomy represents an attempt to combine some of the advantages believed to flow from devolved decision making (including flexibility, innovation, and local responsiveness) with the retention of a commitment to NHS principles and national standards. One of the first vehicles for developing this approach …