By Karen Allen BBC Health Correspondent

It is with the greatest of ease that the word Foundation Hospital has slipped quickly into NHS parlance.

But ask any Trust chairman exactly what it means, and they'll probably be rather vague.

Critics fear that this will simply create a "two tier" health service

Will we be any the wiser after the Queen's Speech which has ushered in a bill enabling the creation of these beacon hospitals?

Probably not because what's being mooted is a structural change, the impact of which may take considerable time to reach patients.

A prospectus setting out more detail the practical implications of the "earned automony" a foundation hospital will gain, is due to be published in the coming weeks.

That hasn't stopped opinions being formed already though.

Three star candidates

There are 46 NHS trusts in England which enjoy three star status which theoretically could become foundation hospitals.

The reality is that by 2004 when the first batch are expected to come on stream, only a handful will have made the switch - many senior managers preferring to adopt a "wait and see" policy instead.

It could mean that the less "sexy side" of health care loses out

Using the principle of "earned autonomy" good performing hospitals will have the chance to opt out of Whitehall control and become non-profit making organisations.

They will be able to own and manage their own assets, plough "surplus" back into the Trust and, crucially, determine their own staffing policy.

In principle that could mean better facilities; joint ventures with the private sector; expansion of services and more hospital branding.

But it could also mean that the less "sexy side" of health care - like chronic illness - loses out with fears that more autonomy could allow these elite hospitals to cherry pick the patients they treat.

Poaching fears

Differential wage rates are what worries observers most; because of fears that they will be able to poach staff from neighbouring hospitals.

Officials privately question how different these proposals are to the Conservatives fundholding "reforms" of family doctors

Not just nursing staff and specialist doctors but also the low paid radiographers; hospital secretaries and physiotherapists for whom a extra couple of thousand in their pay packet (or perks in kind) could persuade them to relocate.

Critics fear that this will simply create a "two tier" health service with the elite hospitals performing better and the struggling ones getting progressively worse.

Many question to what degree will these hospitals be free from Whitehall control.

They will still be under pressure to plan services; meet targets etc but may be able to shrug off the micro-management of which ministers have been accused.

Certainly, the ability to raise funds independently of Whitehall will be attractive to some ambitious trusts - but just how much freedom will the get?

Taxpayer

A regulator will have the power to cap the amount they borrow and what happens if it all goes horribly wrong - will it be the taxpayer that picks up the tab?

Senior figures in the health service have been cagey about committing to the idea - some primary care trust officials speaking privately question how different these proposals are to the Conservatives fundholding/non-fundholding "reforms" of family doctors, which Labour was so quick to dispense with once it came to power.

Its political opponents have been quick to accuse Labour of hypocricy but as they say, the devil will be in the detail.