Frank Dobson, the former secretary of state for health, renewed his attack on one of the central features of planned NHS reforms yesterday, by warning doctors that foundation hospitals would undermine their right to choose how patients are treated.
The new-style hospitals, meant to set new standards of excellence for other NHS trusts to emulate, will be given so much financial clout that they will start to displace primary care trusts, according to Mr Dobson.
Under reforms which Mr Dobson initiated when he was health secretary in 1997-99, most of the money put into the NHS is now controlled by primary care trusts led by doctors, health visitors, and others in the front line of care.
But Mr Dobson claimed: "According to the advocates of foundation hospitals, their governing bodies, including people elected by patients, will take strategic decisions on priorities. Most of these decisions are now taken by primary care trusts which try to reflect local needs as encountered by GPs and others working in primary care.
"If these sorts of decisions are to be taken by foundation hospitals responsible for providing treatment, what role will be left for the people in primary care? What influence will GPs have?"
NHS hospitals which have been given a top, three-star rating for running efficiently will be able to apply for foundation status, under legislation included in the Queen's Speech. This will give them freedom to borrow money privately and to control their own budgets and set salary levels.
Before the new policy was agreed, the Chancellor, Gordon Brown, fought a successful turf war to restrict the foundation hospitals' right to borrow, on the grounds that the taxpayer would have to rescue hospitals which borrowed recklessly. Any money they raise privately will now count as part of the total NHS borrowing limit.
In the Commons last week, the Health Secretary, Alan Milburn, dismissed claims that foundation hospitals will create an elitist or two-tier service or open the way to privatisation, calling them "a form of public ownership".
At the annual conference of the Dispensing Doctors' Association in York, Mr Dobson warned that foundation hospitals will be "the cuckoo in the local health service nest".
He added: "This emphasis on independent decision-making will encourage foundation hospitals to do their own thing. If things go wrong as a result of financial independence, they will start touting for trade, looking for high fee-paying private patients, even advertising abroad. Making their proper contribution to treating chronic illness is not likely to be a high priority."
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