Twelve flagShip NHS trusts with "foundation" status – supposed to denote gold standard medical treatment and care of patients – have failed to get a clean bill of health from the new regulator of the heath service.
They are among 22 trusts that have been ordered to improve their standards of patient care or face sanctions by the Care Quality Commission (CQC), which was set up last year to oversee improvements in the monitoring of the country's healthcare system.
The failed trusts include Basildon and Thurrock University Hospitals NHS Foundation Trust, where poor standards and care at an accident and emergency unit may have contributed to the unnecessary deaths of more than 400 patients, and Mid-Staffordshire NHS Foundation Trust, where the worst hospital scandal in more than a decade triggered the biggest safety review in the NHS since Labour came to power.
All 378 NHS trusts in England are now registered with the CQC, but 22 must fulfill certain conditions in order to keep their registration. Seven of these have been told to make urgent improvements and the commission could in theory close hospital units, or even an entire trust, if improvements are not made.
Under the new registration scheme, the CQC can also impose fines, launch prosecutions or suspend services at failing trusts. Previous regulators, such as the Healthcare Commission, have only been able to urge ministers to take action. "We will now be monitoring these trusts constantly, carrying out more unannounced inspections and using our tough new enforcement powers to make sure people get better care," said Cynthia Bower, the chief executive of the CQC.
"For 22 trusts, registration is conditional on improvements being made. We have set out the steps we expect to be taken and by when. It is now the responsibility of these trusts to ensure improvements are made. If they fail to act, we will take appropriate action.
"Most conditions were imposed in relation to the care and welfare of people who use services. This makes it clear that some trusts must do more to make sure people experience effective, safe and appropriate care that meets their needs and respects their rights," Ms Bower said.
Of the 22 trusts, 15 are in the acute sector, four are in mental health, two are primary care trusts and one is an ambulance trust. The foundation status is supposed to mean that they give a gold standard level of care to patients and in return receive more autonomy – and funding – from central government.
Foundation trusts were created in 2004, and gave more control to local management teams. Held up by the Government as being at the "cutting edge" of healthcare, they have to show they are financially viable and provide better services in return for the extra freedom.
Around 130 NHS trusts have been given foundation trust status since the scheme was launched. Patients' groups said the fact that a significant number have been told to improve raises questions about their flagship status.
"Foundation trusts are meant to be the Premier League of the NHS. But these results call into question the assessment process and actual status," said Katherine Murphy, director of the Patients' Association. "There is too much emphasis placed on financial performance rather than quality of care. The foundation trust regime needs looking into."
The seven foundation trusts told to make urgent improvements are: Basildon and Thurrock University Hospitals NHS Foundation Trust; Heart of England NHS Foundation Trust; Heatherwood and Wexham Park Hospitals NHS Foundation Trust; Medway NHS Foundation Trust; Peterborough and Stamford Hospitals NHS Foundation Trust; Sherwood Forest Hospitals NHS Foundation Trust; and Tameside Hospital NHS Foundation Trust.
The five others foundations with conditions are: Luton and Dunstable Hospital NHS Foundation Trust; Northern Lincolnshire and Goole Hospitals NHS Foundation Trust; Surrey and Borders Partnership NHS Foundation Trust; Mid Staffordshire NHS Foundation Trust; and Milton Keynes Hospital NHS Foundation Trust.
Mid Staffordshire was subject to an independent inquiry which earlier this year found that patients were subject to "unimaginable suffering" by staff. A report into Basildon and Thurrock also found higher than expected death rates among patients and poor standards of hygiene.