Inside Foundation Trust Hospitals: Using Archetype Theory to Understand How Freedoms Translate into Practice

As part of National Health Service (NHS) system reform in England, a novel type of provider organisation, the foundation trust (FT), was introduced in 2004. FTs were awarded considerably greater operational and financial freedoms relative to other NHS trusts (that is, publicly funded hospital groups), with new governance arrangements that replaced national accountability with accountability to the local community. The intention of the FT policy was that these new organisational forms could then use their freedoms and new governance arrangements to innovate more effectively, and improve their performance in financial management, quality and responsiveness of services delivered. The FT policy was initially developed following observation of similar reforms in other countries, such as Spain, Denmark and Sweden. However, there is very limited publicly available evidence regarding the success of these international reforms.