Most of the 151 aspiring trusts are expected to be approved by Virginia Bottomley, Secretary of State for Health, in the autumn for transition to opted-out status next April.
Despite continuing doubts over the financial viability of some trusts and lingering opposition among many health service professionals, the Government remains determined to maintain the pace of its NHS overhaul and to strengthen the new internal market in health care.
The future of the 14 English regional health authorities is now under review by health ministers, who are discussing proposals to expand the role of the six NHS management executive 'outposts' that currently monitor the performance of trusts.
Baroness Cumberlege, Under-Secretary for Health, said any changes, which will come before ministers in the autumn, would increase accountability. 'The last thing we want is a fat bureaucracy. We want a system which is in tune with more local accountability,' she said in an interview for BBC Radio 4's The World at One.
'We have always said we would have a managed market and clearly somebody has to manage that market.'
Although no firm decisions are expected until next year, no new structure would involve major reorganisation, she added.
Brian Mawhinney, Minister of State for Health, yesterday wrote to the general managers of all hospitals and units that have not expressed an interest in opting out inviting them to join the fourth wave of trusts.
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.
Labour condemned the latest moves as a 'leap in the dark' that could only undermine the future of the NHS. Dawn Primarolo, the party's health spokeswoman, said all money allocated for setting up the new trusts should come on top of the existing NHS budget.
'So far there is no published assessment of the success of even the first wave of trust hospitals.
'All we have is reports of cut-throat commercialisation, expanding privatisation, cuts in services and in staff, but not in waiting lists. Many trusts are in crisis - we must not push the rest of the health service that way.'
The trusts enjoyed no public support and served only to set nurse against nurse and doctor against doctor, she said.
Liz Lynne, the Liberal Democrats' health spokeswoman, said there had to be more consultation with local communities before trusts were set up.
'There must now be real consultation, not just the lip-service we have seen too often in the past.'
The Confederation of Health Service Employees said many trusts were financially unprepared to cope with the status in the new competitive, internal market.Reuse content