New freedoms of foundation trusts to be welcomed, but robust evaluation is key, says The King's Fund

'We support the idea of foundation trusts in principle, but they must be assessed by the five key tests of efficiency, access, quality, accountability and impact on local stakeholders before they are extended to all hospital trusts,' said The King's Fund chief executive, Rabbi Julia Neuberger.

Speaking on the day of the third reading of the Health and Social Care (Community Health and Standards) Bill, Rabbi Neuberger said:

'With a more self-financing, self-governing model and a more devolved approach to health care, foundation trusts represent an opportunity for frontline health organisations to be more innovative, more accountable and more responsive to local need with the potential for improved performance.

'However, it will be important for examples of best practice from foundation trusts to be passed on to non-foundation trusts so that this does not entrench a two-tier system. Rigorous, open and independent evaluation of the management of resources will also be key to ensuring that the new freedoms translate into real benefits for patients and do not have a negative impact on the wider health care economy. Any evaluation should take place within a reasonable fixed timeframe after the first wave of foundation hospitals have been established.'

The King's Fund recommends that foundation trusts are assessed by the five following key tests:

Equity

If foundation trust status produces measurable improvement in services to their patients, has this come at the expense of access to high quality care for patients using non-foundation hospitals?

Efficiency

What has been the effect of foundation trust status on the efficiency of the NHS Trust? What have been the administrative costs of establishing these new organisations and their surrounding regulatory structures?

Access

To what extent have foundation trusts in exercising their freedoms for the benefit of their patients adversely affected the range and comprehensiveness of local services more generally? The evaluation should include an assessment of the impact of foundation trusts on their whole local health economy.

Quality

Has the quality of the foundation trusts in exercising their freedoms of the benefit of their patients, adversely affected the range and comprehensiveness of local services more generally? The evaluation should include an assessment of the impact of foundation trusts on their whole local health economy.

Relationship with local stakeholders

Are first-wave trusts able to demonstrate responsiveness to the local community through their new local governance arrangements? Has patient involvement been used to shape and develop the service the foundation trust provides? What has been the impact and at what cost? Has foundation trust status had any impact on relationships within the local health economy particularly with respect to collaborative working, predominantly for the care of older or chronically ill patients.

Accountability

The King's Fund also believes the relationships and systems of accountability between the foundation trusts, primary care trusts and the Secretary of State and the independent regulator must be made clearer.

Notes to editors: 

1. For further information, or interviews with King's Fund staff, please contact Daniel Reynolds in the public affairs team on 020 7307 2581, or Becky Owens on 020 7307 2585.