A key advisor has warned the government's policy of freeing successful hospitals from Whitehall control risked creating a two-tier NHS.

Adair Turner, a former director of the Confederation of British Industry, and a member of Prime Minister Tony Blair's Forward Strategy Unit, has warned that if the plans for "foundation hospitals" are implemented too quickly, it could split the NHS.

Under the plan, hospitals which achieve the top three-star rating in hospital league tables can have complete freedom to decide how they work.

In May it was announced hospitals in Cambridge, Northumbria, Peterborough, and Norfolk would be applying to join the first-wave of NHS foundation hospitals.

There are very real fears that we could have a two-tier system arising from the advantage being given to foundation hospitals

David Hinchliffe, chairman of the Commons Health Select Committee

And in a survey for BMA News, the magazine of the British Medical Association, eight out of 10 doctors said they believe the introduction of the foundation hospitals could lead to a two-tier NHS.

They fear the ability of those hospitals to be more flexible in what they pay staff could mean nearby trusts have problems recruiting staff.

There are also fears the policy effectively marks a return to the internal market introduced by the Conservatives in the early 80s.

Extra capacity

In a report submitted to Tony Blair, Mr Turner said he was not opposed to freeing hospitals from central government control, the Independent newspaper reports.

But he said it should not be done until the government investment in the NHS creates the extra capacity the service needs.

Adair Turner is looking at long-term plans for the NHS in his report

His report into long-term funding has been submitted to Mr Blair.

It is not due to be published, and Mr Turner is understood to be doing further work on the NHS.

Whitehall sources say Mr Turner's most controversial proposal is that every operation and treatment in the NHS should have a price tag, so GPs and patients can shop around for treatment at NHS and private hospitals, reports the newspaper.

He is said to believe this would allow money to "follow the patient" and supports a move to much more patient choice.

It would also allow a further expansion of the private sector's role on performing NHS procedures.

Mr Turner is also calling for all staff to be given greater responsibility, so nurses would take on some tasks performed by GPs and GPs would be able to relieve the pressure on hospital outpatients departments.

But the Prime Minister's official spokesman insisted that the government would press ahead with its plans for foundation hospitals.

He said: "This is about a process of levelling up, not levelling down, and it is about improving standards right across the board.

"Foundation hospitals will go ahead as planned."

Concern

David Hinchliffe, chairman of the Commons Health Select Committee, told the BBC Mr Turner was right to urge caution.

The Labour MP said: "There are very real fears that we could have a two-tier system arising from the advantage being given to foundation hospitals.

"When it was first mooted by the Secretary of State in a speech last year I was concerned that he echoed very much the language that was being used the Conservative Party in the early 1980s when they introduced the internal market."