At the centre of the row are letters from the health department to all NHS hospitals, including foundation trusts, telling them to appoint extra matrons, undertake an annual deep clean to combat hospital-acquired infections and appoint infection control nurses.

William Moyes, chairman of Monitor, the independent regulator of foundation trusts, has written to NHS chief executive David Nicholson arguing that such instructions amount to line management by the labour government when foundation trusts are meant to be self-governed institutions.

“I do not believe this is consistent with the legislative framework,” Mr Moyes warned the health service’s top boss, because the department’s letter “could only be interpreted as issuing instructions”.

Mr Moyes added it was clear that “there remain different views about who is accountable for the performance of foundation trusts”.

So ministers can no longer set hygiene standards and ensure they are enforced? They can still set standards for hospital cleanliness, which the Healthcare Commission inspects. Monitor requires foundation trusts to meet these and other national standards and targets, such as reducing MRSA infection rates, and can intervene to enforce compliance. But exactly how a foundation trust achieves targets is a matter for them.

But what if there is a known best way of treating patients? Can ministers not make foundation trusts comply?
They can, but not by central direction. National service frameworks, for example, set out approved ways of organising cancer treatment and other services. Primary care trusts are expected to commission care in line with these frameworks. Monitor argues that PCTs should remove services from hospitals that they believe are unsafe or poor quality. PCTs in theory retain the ability to require a deep-clean in a contract.

Like the rest of the NHS, foundation trusts are inspected by the Healthcare Commission. They are answerable to their boards, their governing councils and to Monitor, which authorises them and has the power to direct them and replace their boards.

If problems arose over performance, Mr Moyes warned foundation trust chairmen and chief executives in a separate letter, “it will be no excuse to say you were simply operating within a framework defined by the Department of Health or the strategic health authority”.

The correspondence amounts to a battle for the operational independence of a key part of the government’s reforms, which were meant to end “command and control” from Whitehall and shift responsibility for performance to freer-standing institutions, regulators and the primary care trusts who commission hospital care.

The health department’s letter followed headline-grabbing announcements at Labour’s?party conference by Gordon Brown, prime minister, and Alan Johnson, heath secretary, over hospital deep-cleans and the appointment of 5,000 extra matrons. However, the health department later admitted it no longer had the power to order a foundation trust to appoint matrons.

Mr Moyes said PCTs should not commission care from dirty and unsafe hospitals and should specify their requirements in contracts. If foundation trusts failed to deliver that, then the right approach was for the NHS chief executive to “invite Monitor to act, using its statutory powers”.

On Tuesday, Mr Nicholson tried to defuse the row, declaring: “I fully support the autonomy of NHS foundation trusts and the role of Monitor as their regulator.

“I am also clear that every NHS board has – as part of the NHS family – a very real duty on behalf of their patients to learn lessons” to prevent a repeat of the infection scandal at the Maidstone NHS Trust, where 90 people died from Clostridium difficile.

The Foundation Trust Network, which represents the trusts, said: “It is important that Monitor maintains its status as an independent regulator able to challenge if hard-won freedoms are eroded.”

From:
http://www.ft.com/cms/s/0/9fff97bc-df3f-11dc-91d4-0000779fd2ac.html?nclick_check=1