With 156 already in existence, nearly two-thirds of hospital and community health services will be self-governing from April and ministers are expected to announce next week applications for a fourth wave that should see almost 90 per cent of the service being run by trusts by 1994.
The Government wants the whole of the NHS to be under the control of trusts before the next election, although no 'diehard' directly-managed unit will be forced to make the transition.
Mrs Bottomley combined yesterday's announcement at the Conservative Party conference in Brighton with the most bullish assessment yet from a Cabinet minister of the spending round. Other ministers have ducked and dived over spending commitments, but Mrs Bottomley, asked if she could guarantee that the manifesto commitment of real growth next year in the NHS would survive, replied: 'It will survive. I stand by the manifesto commitment'.
Michael Portillo, Chief Secretary to the Treasury, is being told that not only is the manifesto commitment on the line, but so is the Prime Minister's word, given his election campaign statement that the NHS would see growth year on year. However, the pay review bodies of doctors and nurses are to be told next week by Brian Mawhinney, the Minister for Health, that there is room for little or no pay increase next year given the economic situation.
A possible victim of the spending round is the extension of the Patient's Charter to set limits on outpatient waiting times. Mrs Bottomley said she was telling every region now to set targets for out-patient times. Health ministers suspect privately, however, that progress will be limited by lack of cash. On the conference floor, Mrs Bottomley faced unprecedented calls for a ban on tobacco advertising, but maintained the Government's reluctance to countenance one until the department's review of the effectiveness of advertising bans elsewhere is complete.
The Secretary of State has decided that the following 12 hospitals and other units should not be established as Trusts, though she gave no explanations.
NORTH EAST THAMES: Essex & Herts Unit (West Essex Health Services Unit); Newham Healthcare; Tavistock & Portman Clinics.
NORTH WESTERN: Stockport Health Services; Tameside & Glossop Health Services.
SOUTH EAST THAMES: Medway & Swale Healthcare; Queen Victoria Hospital East Grinstead.
SOUTH WESTERN: Plymouth Acute Services Unit.
TRENT: Derbyshire Royal Infirmary.
WEST MIDLANDS: Yardley Green Unit, East Birmingham District.
YORKSHIRE: Dewsbury Health Care; Hull & East Yorkshire Community Services.
The NHS trusts to be established are:
EAST ANGLIA: Addenbrooke's; East Suffolk Local Health Services; Ipswich Hospital; James Paget Hospital; Lifespan Health Care Cambridge (Cambridge Community); Mid Anglia Community Health; North West Anglia Healthcare; Papworth Hospital; Peterborough Hospitals; West Suffolk Hospitals.
MERSEY: Countess of Chester Hospital (Chester Acute); Cheshire Community Healthcare (Crewe); Halton General Hospital; East Cheshire (Macclesfield); Southport & Formby Community Health Services; Warrington Community.
NORTH EAST THAMES: BHB Community Health Care; Camden & Islington Community Health Services; Chase Farm Hospitals; Enfield Community Care; Havering Hospitals NHS Trust; Mid-Essex Community Health NHS Trust; Redbridge Healthcare; Royal London Homoeopathic Hospital; Thameside Community Health Care; Whittington Hospital.
NORTHERN: Cumbria Ambulance Service; Durham County AS; Northumberland Mental Health; Gateshead Hospitals (Queen Elizabeth & Bensham); South Cumbria Community & Mental Health; South Tees Community & Mental Health; South Tyneside Health Care; South West Durham Mental Health; Westmorland Hospitals; West Cumbria Health Care.
NORTH WESTERN: Calderstones NHS Trust; Mancunian Community Health NHS Trust (South Manchester); Wigan & Leigh Health Services; Chorley & South Ribble; West Lancashire.
NORTH WEST THAMES: Bedfordshire and Hertfordshire Ambulance Services; West London Healthcare (Ealing Community/Mental Health); Hounslow & Spelthorne Community & Mental Health; Bedfordshire & Shires Health & Care (North Bedfordshire Community Health); Northwick Park Hospital; Riverside Mental Health; West Middlesex University Hospital.
OXFORD: East Berkshire Community Health; Horton General Hospital; Oxford Learning Disability; Radcliffe Infirmary; Royal Berkshire Ambulance; Royal Berkshire & Battle Hospitals (West Berks Acute Services); South Buckinghanshire (Wycombe Health Authority); Two Shires Ambulance (Northants and Bucks); West Berkshire Priority Care Service.
SOUTH EAST THAMES: Brighton Health Care; Bromley Hospitals; Canterbury & Thanet Community Healthcare; Eastbourne & County Healthcare; Greenwich Healthcare; Kent & Canterbury Hospitals; Mid-Kent Healthcare; Queen Mary's Sidcup; Thanet Health Care.
SOUTH WESTERN: Avalon (Somerset Mental Health); Royal Devon & Exeter (Exeter Acute); Gloucester Royal; Severn (Gloucestershire Community).
SOUTH WEST THAMES: Crawley & Horsham; East Surrey Hospital & Community Healthcare; Merton & Sutton Community; Richmond, Twickenham & Roehampton Healthcare; Worthing Priority Care.
TRENT: Barnsley District General Hospital; Central Notts Healthcare; Chesterfield and North Derbyshire Royal Hospital; Derby City General Hospital; West Lindsey (Gainsborough and District Health); Glenfield Hospital; Leicester Royal Infirmary; Leicester General Hospital; Fosse Health; Leicestershire Community; Notts Ambulance Service; Queen's Medical Centre; Nottingham University Hospital; Rotherham General Hospital's NHS Trust; Rotherham Priority Health Services; Community Health Services, Southern Derbyshire; Southern Derbyshire Mental Health; South Lincs Community & Mental Health Services.
WESSEX: Andover District Community Health Care; North Hampshire, Loddon Community; Dorset Ambulance Service; Hampshire Ambulance Service; Isle Of Wight Community Healthcare; Portsmouth Hospitals; St. Mary's Hospital (Isle of Wight Acute); Southampton University Hospitals; Southampton Community Health Services; Wiltshire Ambulance Service.
WEST MIDLANDS: North East Worcestershire Community Health Care (Bromsgrove and Redditch Community Health Services); Burton Hospitals; Good Hope Hospital; Wolverley (Kidderminster and District Health Service Unit for People with Learning Difficulties); Kidderminster Healthcare (Kidderminster General Hospital); North Warwickshire Healthcare (Community and Mental Health Services); North Staffs Hospital Centre; Mid Staffordshire General Hospitals; Shropshire Mental Health; South Warwickshire General; South Worcestershire Community; The Princess Royal (The Princess Royal Hospital, Telford); Walsall Community Health Services.
YORKSHIRE: Calderdale Health Care; East Yorkshire Hospitals; Grimsby Health; Huddersfield; Royal Hull Hospitals; Humberside Ambulance Service; Leeds Community & Mental Health Services Teaching NHS Trust; North Yorks Ambulance Service; Pinderfields Hospitals; Pontefract Hospitals; Scunthorpe and Goole Hospitals; Scunthorpe Community Health Unit; West Yorks Metropolitan Ambulance Service; Wakefield and Pontefract Health.
The Secretary of State will announce her decision after further assessment of the following units.
MERSEY: Warrington Acute Unit.
NORTH WEST THAMES: Parkside Mental Health Services; Teddington Memorial Hospital. WEST MIDLANDS: West Midlands Metropolitan Ambulance Service.
The following three applications involve mergers between existing trusts and directly managed units. The Secretary of State will announce her decision after further consultation with staff.
SOUTH WESTERN: Cornwall Health Care (Eldercare Unit); West Country Ambulance Services. WEST MIDLANDS: Coventry, Warwickshire & Walsgrave Hospital.
The following application is currently the subject of further consultation on a proposed change in the services to be included in the trust
SOUTH WEST THAMES: Mayday Health Care (Croydon).
The Secretary of State will make an announcement about the four London Teaching Trusts deferred last year, along with St. George's Healthcare, which applied this year. The four deferred trusts are: St Thomas' Hospital, King's Camberwell, City & Hackney and St Mary's.
Two units withdrew their applications: North West Herts Acute Services and Newcastle Rehabilitation North.Reuse content