dow-dressing of a local "stakeholders" group, the day to day decisions will be taken by the same old board of executive directors - or the "non-profit" label: foundations will be encouraged to act just like for-profit firms, in an 'entrepreneurial' way, striking deals with private sector companies.
Foundation Trusts that wish to borrow money for expansion will be obliged to compete against other NHS Trusts for additional contracts to raise the money to pay back the bankers. One accountant has calculated that to service borrowing equivalent to a quarter of their turnover, foundations would have to double their income.
Some of the. 29 applicants have already begun floating deals with private companies: the Nuffield Orthopaedic Centre in Oxford is looking at a deal to carve up additional private patients with a private hospital, while UCLH is also seeking a deal with a "major pathology company". Moorfields Eye Hospital is looking to boost its private sector operations before it gets foundation status.
Foundation hospitals in Spain are accused of creaming off the most lucrative shortstay patients, and leaving the more complex, costly and unpredictable work to the mainstream health service hospitals. This way they get to appear very efficient, and also retain a surplus that can be used to pay more money to top bosses and doctors.
The best-known foundation hospital in Sweden, St Goran's in Stockholm, was privatised by its board - and sold off to the private hospital company Capio, that is now in the bidding for more NHS contracts in Britain: the Swedish government immediately passed new legislation to prevent further privatisation of hospitals. A network of DTCs.
These are expected to attract a growing share of the "elective" (waiting list) cases