The best-run mental hospitals and mental health trusts will be allowed to break away from NHS management by applying for "foundation" status in the next stage of NHS reform.
The move is part of a drive to devolve the running of the NHS away from London. But it will prompt fears that mental patients who do not have a solid family network – the people on whose behalf The Independent on Sunday has been campaigning for months – could be left in the care of poorly run and underfunded NHS trusts while the luckier patients are taken over by the new foundation trusts.
Alan Milburn, the Secretary of State for Health, hinted at the change when he told MPs: "We want as many NHS hospitals as possible to become NHS foundation trusts, as quickly as possible."
A source at the Department of Health confirmed afterwards that this implied that any NHS institution, including primary care trusts, ambulance stations and mental hospitals, will eventually be able to apply to break away from NHS management control and operate its own budget, with its own pay rates, under the control of its own elected board.
The idea of turning mental health trusts over to elected boards was greeted with scepticism by critics of government health reforms. Labour MP Julia Drown said: "I think the priority should be improving all mental health facilities, not trying to offer extra incentives to those that are already doing well."
Legislation due to go before the Commons this summer will allow hospitals with three-star rating to apply to become the NHS's first foundation trusts, with management boards made up of people who live or work in the areas served by the hospitals.
Mr Milburn is hoping that freeing the best-run mental health trusts from central control will provide others with an incentive to run themselves more effectively. But critics will say that it will mean that mental patients with loving families who understand the system will be placed in foundation hospitals, which will have bigger budgets and better-paid staff, while those with no one to fight for their interests will be confined to poorly run NHS institutions.
At present, just four of the 86 mental health trusts have been given a three-star rating: the Barnsley Community and Priority Services Trust, the Dorset Health Care Trust, the Guild Community Health Care Trust in Preston and the South Birmingham NHS Trust.
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