The government last week named of the 29 hospitals in England that will make up the first wave of applicants for the controversial "foundation" hospital status.
The trusts will have freedom from Whitehall control and will be able to set their own pay rates, as long as doing so "does not undermine the ability of other providers in the local health economy to meet their NHS obligations."
The plans have met widespread opposition from NHS staff and MPs alike, with 60 Labour MPs voting against the government on the plans last week.
The applications for foundation trust status must be submitted by the autumn, and the successful hospitals (subject to parliament passing the Health and Social Care Bill) will be granted trust status in April 2004.
The trusts must now submit detailed plans to the Department of Health to outline their vision of how they will use the freedoms to improve patient care. The plans must also include details of the composition of their boards and their human resources policies.
All 29 trusts are "three star" (top rated) hospitals, but the health secretary, Alan Milburn, said they would have to withdraw their application if they slip back in the next round of league tables, due out in the next few months
Mr Milburn said: "Where these first 29 lead, I hope the rest of the NHS will follow. Subject of course to parliament, I want every NHS hospital to have the opportunity of becoming an NHS foundation trust over the next four to five years."
A report by the House of Commons health select committee earlier this month said that this aim was ambitious. The report reiterated many people's misgivings about the trusts.
It said: "We believe that the introduction of foundation trusts, coupled with increased patient choice, has the potential to alter the distribution of hospital services . . . Early implementers of foundation status will attract more resources, as well as perhaps attracting more and higher calibre staff, which given current shortages in many professions may be at the expense of other worse performing hospitals. The potential for inequity posed by foundation trusts therefore needs to be addressed" (10 May, p 1000).
The Department of Health was keen to point out that 12 of the trusts are in the most economically deprived parts of the United Kingdom. One such hospital is the Walsall Hospitals NHS Trust, whose chief executive, John Rostill, said that local people would certainly gain from foundation status, not least because as part of the deal the trust would get £5m ($8m; €7m) a year more than it does already.
He added that the community's wishes would be central to the trust's plans: "Foundation trusts are under the social ownership of the local community. We have been critical of a top down approach from the secretary of state, so we would not want to continue it in a local setting."
He added: "I have already spoken to the senior medical staff committee, and they are in favour—some very enthusiastically—as they see it as a chance to get away from the shackles of a centralised bureaucracy."
The foundation hospital scheme applies only to England. The 29 trusts are Addenbrooke's; Aintree Hospitals; Basildon and Thurrock General Hospitals; Bradford Hospitals; Calderdale and Huddersfield; City Hospital Sunderland; Countess of Chester; Doncaster and Bassetlaw Hospitals; Essex Rivers Healthcare; Gloucestershire Hospitals; Guy's and St Thomas's Hospital; Homerton University Hospital; King's College Hospital; Moorfields Eye Hospital; North Tees and Hartlepool; Nuffield Orthopaedic Centre; Papworth Hospital; Peterborough Hospitals; Rotherham General Hospital; Royal Devon and Exeter Healthcare; Sheffield Teaching Hospitals; Southern Derbyshire Acute Hospital Services; Stockport; Newcastle upon Tyne Hospitals; Royal Marsden; Queen Victoria Hospital, west Sussex; University Hospital Birmingham; University College London Hospitals; Walsall Hospitals.
Three other trusts submitted but later withdrew bids: East Cheshire, Royal National Hospital for Rheumatic Diseases, and Frimley Park.