Changes to the Health and Social Care Bill: providers

The comparison below sets out the Health and Social Care Bill's initial proposals as regards providers, what has now changed and some key questions that remain unanswered.

The original proposals in the Health and Social Care Bill

  • All NHS trusts to become foundation trusts by 2014 (NHS Trust Development Authority to assist with the transition).
  • Controls on mergers and acquisitions relaxed to facilitate takeovers of failing NHS trusts.
  • Providers unable to compete will be allowed to fail. Monitor to have powers to ensure continuity of services at a local level by 'designating' them.
  • Private patient income cap on foundation trusts to be lifted.

What has changed in the proposed reforms?

  • The 2014 deadline for all NHS trusts to become foundation trusts has been relaxed, although the majority will still be expected to meet this deadline.
  • Monitor's oversight of foundation trusts will be extended to 2016 to allow time to build capability of governors.
  • Foundation trusts will be required to hold board meetings in public.
  • All providers are to be placed under a 'duty of candour' requiring them to be open and transparent in admitting mistakes.
  • Amendments to be brought forward at a later stage to revise the failure regime.
  • Foundation trusts will be required to produce separate accounts for their NHS and privately funded activities.

What is still unanswered?

  • How can NHS trusts be helped to achieve foundation trust status in the current financial context?
  • Will necessary decisions be taken to reduce and in some cases close services?
  • What will happen to NHS trusts that are not able to achieve foundation trust status by 2014?
  • What will the new failure regime look like?