Don't sell the pass, Dr Reid

Today's vote in the Commons on foundation hospitals has been preceded by an attempt by the Health Secretary, Dr John Reid, to persuade recalcitrant Labour backbenchers to rethink their entrenched opposition to the idea. His approach has been to suggest that foundation hospitals are not, after all, such a major departure and that in any event, they will be solidly grounded in their local communities.

Dr Reid must not water down the foundation hospital initiative even more than it has been already. The whole idea was to liberate the best performing hospitals from the centralised control of a monolithic NHS and to give them a greater degree of financial autonomy.

This acknowledged the self-evident truth that the health service does not perform equally well at all levels and that improvements in this unwieldy system can best be achieved by rewarding models of best practice within it.

Former Health Secretary Frank Dobson writes in this newspaper today that staff are reluctant to face another upheaval. Indeed, change may not mean an easy life for them. But the NHS needs substantial reform if the billions being poured into it are to benefit patients fully.

One of the admirable aspects of the proposal was that it sought to involve local people in the running of their hospitals by representing them on their boards. Now that ambition may be turned into a hurdle for the new foundations. A group of MPs, backed by the Government, has tabled an amendment which would place a legal duty on the foundation hospitals to ensure that the boards are "grounded in the local community" and would oblige the boards to report annually on their progress.

Of course, arrangements must reflect the fact that what may suit a small town will not work for a mixed, transient inner London population. But MPs must not reintroduce the kind of restrictive bureaucracy which the Government has tried to avoid. Dr Reid should take care that his critics do not paint him into a corner.