Where next?

Much heat and light have been generated in the media recently as a result of the second reading in the House of Commons of the Health and Social Care Act 2003. The most controversial aspect of the bill was the proposal to allow NHS trusts to become NHS foundation trusts, with extra freedoms to run their affairs compared with other NHS trusts.1 Three main freedoms have been granted. Firstly, foundations can borrow capital, sell assets, and importantly retain in-year surpluses. Secondly, direct control from the Department of Health will be relaxed and greater managerial freedoms granted-for example, to reward staff-and foundation trusts will be accountable to a new independent regulator. Thirdly, more freedoms will exist with respect to how foundation trusts are governed, although they will have to establish a new board of governors elected in part by local communities.