Governance for NHS foundation trustsBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7382.174 (Published 25 January 2003) Cite this as: BMJ 2003;326:174
Mr Milburn's flawed model is a cacophony of accountabilities
- Rudolf Klein, visiting professor
- London School of Economics, London WC2A 2AE
Now that England's health secretary, Alan Milburn, has published his Guide to NHS Foundation Trusts,1 it is apparent that the proposed model is more radical in its implications but also more problematic in its implementation than had been anticipated. It is radical in that it is based on a new notion of social ownership modelled on cooperative societies and mutual organisations: the rhetoric of devolving power in the NHS is, in effect, to be institutionalised by transferring control to the “local communities” served by foundation trusts. Moreover, the first generation of foundation trusts is seen as preparing the way for their status becoming the norm in the NHS in time. If so, then the relation between centre and periphery in the NHS could change dramatically. It is problematic, however, in that the proposed system of governance for foundation trusts could make those working in them look back nostalgically to the days when their chief concern was about the heavy hand of central government.
Some of the initial fears about foundation trusts were clearly misplaced. They do not represent a backdoor form of privatisation. They will not be given a free hand to expend their facilities for treating fee paying patients: the percentage of income derived from this source is …