Intended for healthcare professionals


The first wave of NHS foundation trusts

BMJ 2004; 328 doi: (Published 03 June 2004) Cite this as: BMJ 2004;328:1332
  1. Rudolf Klein (, visiting professor
  1. London School of Economics, London WC2A 2AE

    Low turnout in elections sends a warning signal

    On 1 April 2004 the first 10 NHS foundation trusts came into being while another 14 remain on the starting line, awaiting the approval of the independent regulator.1 So begins an experiment that has the potential to transform the NHS, but in which formidable obstacles remain in the way of translating ambitions into reality. In launching the experiment the government set out two linked aims—decentralisation and democratisation.2 Firstly, foundation trust status would give providers “freedom from Whitehall control.” Secondly, it would introduce “a new form of social ownership where health services are owned by and accountable to local people rather than to central government.”2 We do not know how much freedom from Whitehall control will exist in practice and how much scope foundation trusts will have to develop new ways of working. During the passage of the legislation through parliament, the government was forced to appease backbench opposition by introducing a series of restrictions on the way in which foundation trusts can run their affairs. …

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