Intended for healthcare professionals


Foundation trust status makes little difference to performance, finds study

BMJ 2011; 343 doi: (Published 11 July 2011) Cite this as: BMJ 2011;343:d4434
  1. Adrian O’Dowd
  1. 1London

Giving “foundation” status to a hospital trust doesn’t improve its clinical or financial performance, concludes a new study by health experts.

An analysis of trusts’ performance by York University showed that giving hospitals in England the greater independence promised with foundation trust status did not automatically lead to enhanced productivity and performance, as expected.

A team of researchers from the university’s Centre for Health Economics discovered that differences between trusts were of long standing and existed before foundation trusts were introduced in 2004, with the expectation that they would achieve high productivity, greater innovation, and better care.

The centre’s team compared the performance of hospitals that became foundation trusts with those that did not, using data covering a seven year period (2002-3 to 2008-9) before and after the introduction of foundation trusts.

The analysis focused on key measures of financial performance, clinical quality and performance (such as waiting times and rates of meticillin resistant Staphylococcus aureus (MRSA)), patients’ safety (indicated by NHS staff reports of “near misses” and errors), and staff satisfaction.

The report says: “Results confirm that the FT [foundation trust] policy per se has made no change in the financial performance of FTs relative to non-FTs, as measured in terms of surplus and RCI [reference cost index].”

On infections, the researchers found a similar picture, saying that their findings “suggest that the introduction of the FT policy has made no impact on the quality of patient care as measured by lower MRSA rates.

“The difference in MRSA rates between FTs and non-FTs pre-exists the introduction of FT status, and the general decline is probably due to greater pressure on all acute trusts to reduce their infection rates and closer monitoring.”

The centre’s director, Maria Goddard, said, “Our research basically shows that the policy of greater autonomy seems to have made no difference. Some hospitals were better than others to begin with, and over time they have all converged.

“The governance arrangements for foundation trusts have not been a costless activity. These costs cannot necessarily be set against expectations of enhanced performance.”

The 137 foundation trusts in England (59% of all hospital trusts) are generally reported by their regulator, Monitor, to do well in terms of meeting national quality and performance standards.

Foundation trusts are still a key part of the present government’s plans to devolve more control to the local level. Most remaining non-foundation trusts are expected to gain foundation status by 2014.

Sue Slipman, chief executive of the Foundation Trust Network, which represents foundation trusts, said, “I accept the proposition that foundation trusts up to now have been the best performers, but we are now going through a period where foundation trust status and the financial disciplines will be opened up to those who haven’t been the best performers in the system, and that seems to me to be the greater test of the model going forward.”


Cite this as: BMJ 2011;343:d4434


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