Some NHS workers fear patient care could be compromised

What do NHS staff on the front-line of patient care think of "super hospitals"? BBC News Online investigates.

Barbara, a 52-year-old nurse working in one of the 30 UK hospitals seeking foundation status, is against the proposals.

She says she is "anxious" about the plans, fearing patient care in some hospitals might suffer.

"The creation of a two-tier Health Service is to me quite real," she told BBC News Online.

"Unless we bring up the poor-performing trusts to a higher level it cannot be good for patient care."

Barbara, now a staff sister, believes that elite hospitals could bring health inequalities into the NHS.

"Will we still maintain the levels of service for all patients?" she asked.

It could create an absolute monster with the destabilisation of local employment markets

"Will the hospitals in poor-performing trusts still get the level of funding needed to maintain services?

"These are usually in poor, deprived areas. These local communities cannot be disadvantaged any further."

Another concern is the effect on staff morale. Foundation hospitals have more freedom to set their own pay scales and could poach staff from other hospitals.

"It could create an absolute monster with the destabilisation of local employment markets," she added.

Although Barbara, who lives in Central England, is disturbed by the plans for elite hospitals, she still wants to stay in the NHS.

She says she cares about her patients passionately and, after 25 years in the profession, would not stop nursing because of the plans.

Stephen Groves, clinical nurse manager of Accident and Emergency at the North Tees and Hartlepool NHS Trust, believes foundation hospitals are a good thing.

"I think it will give more autonomy locally to make decisions about how we spend money to meet the needs of our local community," he told BBC News Online. "It will make us more accountable to people locally."

He says foundation status will enable trusts to direct funds to areas of need and help staff to work "better and more smartly". Patients will hopefully see a better service, he added.

It's a new opportunity to look at how we're providing care for the local community

"Breaking free of some of the constraints of central government will allow us to develop care in more innovative ways - which is what government is encouraging us to do."

One possibility is to provide some acute services in the community. Other options include working in a different way with residential homes to enable patients to leave hospital quicker.

Mr Groves, aged 40, has been working in the NHS for 17 years. He thinks foundation hospitals are a new opportunity to deliver better patient care in areas such as A&E.

"It's come at the right time," he said. "It's a new opportunity to look at how we're providing care for the local community."

He believes fears of a two-tier NHS are unfounded; hospitals have got to work together and learn from each other.

"I hope the organisations that aren't at the stage of being able to achieve 3-star status will learn from hospitals like ourselves with 3 stars," he said.

The North Tees and Hartlepool NHS Trust is one of the 32 hospitals that have applied to become foundation hospitals.