NHS Hospitals granted foundation status despite a plethora of failings

More than 20 hospitals which failed to meet basic health care standards have been awarded "foundation trust" status allowing their bosses to take massive pay rises, an investigation has revealed. Ministers promised that only the best hospitals would be given the freedom to run their own affairs, including setting salary levels which have brought huge pay boosts for senior managers.

Yet investigations by this newspaper show that 22 hospital trusts in the past three years have been given the coveted status despite a range of serious failings including high rates of superbugs, delays treating cancer and heart attack victims, long waits in Accident and Emergency (A&E) departments and lack of proper care for the elderly and the mentally ill.

Patients groups described the revelations as "a shocking exposure" of a regulation system which they said was failing to protect patients or provide the public with any reassurance about where good hospital care could be found.

In a separate development, an investigation has been launched into care standards at a foundation trust which suffers from the highest death rate in England. External consultants have been called in by Basildon and Thurrock University Hospitals NHS Foundation Trust, in Essex, which was among the first wave of trusts awarded foundation status in 2004, but which last year had a mortality rate 32 per cent above expected. The trust believes the high rate is due to data errors, a lack of local hospice places and a high incidence of heart and respiratory disease among local residents.

When Labour introduced foundation trusts, then-health secretary Alan Milburn said that winning the status would be a challenging process "even for the best performing hospitals" who would have to demonstrate high standards of care. Those awarded the status include Mid Staffordshire Foundation trust, which runs Stafford Hospital, where hundreds of people died amid conditions which left dehydrated patients forced to drink out of flower vases while others were left lying in soiled linen. Board papers reveal that the regulators who granted the license to give the trust "foundation" status were aware of a litany of failings in patient care in Mid Staffordshire. At the point the authorisation was made, the trust was missing government targets to reduce MRSA, had long waits in A&E, and for clot-busting treatment for heart attack victims, the documents from Monitor, the regulator, show.

A further 21 trusts were also given the coveted status despite concerns about the quality of the care they provided. As Monitor sent the letters of authorisation it simultaneously issued the trusts with "side letters" highlighting the problems with patient care.

At the point the trusts were awarded the status, 18 were missing or about to miss targets to reduce levels of the superbug MRSA; three had long delays for cancer patients; and four were unable to give urgent treatment to heart attack victims who required clot-busting drugs. Two had been assessed as providing "weak" services for the mentally ill, one had been criticised for staff shortages in paediatric wards, and one was found to be failing to look after frail and elderly patients.

Three of the trusts, including Mid Staffordshire, had high death rates which were discussed during Monitor's board meetings. The documents identify Medway trust in Kent – granted foundation status in October 2007 – as being in the worst 10 per cent of trusts for mortality. Blackpool Fylde and Wyre trust had above-average mortality rates in 2005/6, the documents show, but Monitor granted it foundation status in Dec 2007 after being assured the rates were reducing. Since then, they have risen.

When United Bristol Healthcare trust was granted foundation status last May it had failed the latest annual targets to reduce MRSA, it had high levels of the infection Clostridium difficile, and its patients faced long waits in A&E.

Foundation trusts have more autonomy to run their own affairs and set their own levels of pay. The average pay for their chief executives is now £157,000 – 18 per cent more than that received by those running standard NHS hospitals.

Katherine Murphy from the Patients' Association said the failings identified in the authorisation process undermined claims by foundation trusts that they could offer the best care. "The public has been given the impression that these hospitals are the best. When hospitals are given foundation status despite all these failings, the term just becomes a way for trust boards to give more pay to senior managers," she said.

Norman Lamb, the Liberal Democrat health spokesman, added: "It is really worrying, especially given what we have found out recently about Stafford Hospital, to see that the threshold for foundation status appears to be lowering. "It is absolutely critical that quality of care is the priority when these trusts are being assessed," he added.

A spokesman for Monitor said the regulator would only authorise a trust's application if it had robust action plans to improve its performance, and said the issuing of "side letters" did not represent a lowering of the bar for applicants, but a mechanism to ensure that their performance was closely monitored.

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