National Health Service Foundation Trusts seem to be performing rather well on the financial side, generating a surplus of £376 million for the nine months to December 31, 2007, but targets on infection control are in danger of being missed, according to the latest quarterly report by independent regulator Monitor.

Foundation trusts were set in law in 2003 to give high-performing NHS trusts greater freedoms to move away from central government control and give local communities responsibility for delivering acute healthcare services, the idea being to give FTs more autonomy in managing their own affairs, with more financial and operational freedom, while being assessed by an independent regulator.

Unlike NHS trusts, FTs are not performance managed by the Department of Health through strategic health authorities, and each has a duty to consult a board of governors - consisting of patients, staff, members of the public and other key stakeholders - in the strategic planning of operations, thereby allowing the best decisions to be made in the interests of the local population.

For the nine-month period, 83 FTs booked total revenues of £11.6 billion, £189 million ahead of their aggregate plans. The surplus generated - which came in 112% above target - indicates that they are more than capable of handling the financial side of healthcare provision, but it does perhaps also indicate a certain reluctance to plug more money into further developing service delivery or investing in high-calibre staff, for example, which could drive further improvements in patient care and help to implement longer term strategic plans.

Infection control improving
On the service side, progress is also being made in terms of infection control – a key measure of performance. However, while the overall number of cases of the notorious superbug MRSA in FT hospitals continues to fall, Monitor stresses that “the trajectory must accelerate” if trusts want to meet the year-end target.

At the end of the quarter, 24 out of 83 FTs had already missed their full-year target of cutting cases of MRSA, while a further 11 said they were in danger of doing so. Consequently, these 35 FTs were required by Monitor to prepare “a detailed action plan” of how the trust plans to address the shortfall in service delivery, and the regulator held meetings with seven of these to assess the effectiveness of the plans in more detail.

According to Monitor, two key problem areas were evident right from the start: first, that where an FT board is not meeting the infection target, the board is not properly anticipating the risks and then providing the leadership needed to address those risks; and second, that boards are not placing enough focus and effort towards cooperation in delivering integrated local healthcare solutions.

But commenting on the report, Sue Slipman, director of the Foundation Trust Network, said it is clear that FTs are taking the issue of tackling MRSA seriously, and she welcomed the continued downward trend in rates.

According to Slipman, some of the best performing FTs are at risk of breaching targets “not because they don't understand the issues and challenges posed by MRSA, but because they have already reduced their levels infection to very low numbers,” and she stressed that the current trajectory target system “penalises those with low levels of MRSA unfairly - and puts them at risk of breach when they are dealing, for example, with less than ten cases of MRSA a year”.

93% ‘deep cleaned’
Meanwhile, on the other side of the fence, Health Secretary Alan Johnson said that 93% of NHS trust hospitals had completed their local deep clean programme by the end of March, and that the rest are “well on the way to completion”.

Furthermore, he announced that Specialist Healthcare Commission inspections to check whether hospitals are meeting and maintaining standards of cleanliness will kick off this month, in a drive to cut down on hospital-acquired infections such as MRSA and Clostridium difficile.

“To ensure that trusts maintain high levels of cleanliness, new teams of specialist inspectors will soon be monitoring every trust in England to ensure that they are meeting the standards set in the Hygiene Code”, Johnson promised.