Alan Milburn has announced a shake-up of the way NHS hospitals operate, with a tier of top hospitals getting freedom from Whitehall to run their own affairs.

The health secretary said on Tuesday that successful NHS managers will be allowed to create "foundation hospitals". Failing hospitals could be taken over by charities or the private sector.

Forum Response: King's Fund

A spokesman for the King's Fund told ePolitix.com: "The health secretary's announcement of greater freedoms for NHS trusts will be welcomed by patients, staff and managers alike."

"The NHS has for too long been managed in every aspect by politicians and civil servants. NHS managers currently have little room to respond to local needs after meeting the targets set by the government."

"For the NHS to be truly free of central control, however, it is vital for all organisations - hospitals, primary care trusts and strategic health authorities - eventually to become self-governing within a clear system of regulation and patient power. The whole of each local health system, in other words, should in future be able to work together on the same basis, whatever each organisation's star rating happens to be."

"The King's Fund would also like to see much more involvement of communities in running local NHS bodies. Simply handing over power from civil servants to private organisations will not achieve the government's stated aim of making the NHS more responsive to patients. For this to happen, NHS organisations should be directly accountable to the citizens they serve."

Forum Response: Royal College of Nursing

Dr Beverly Malone, general secretary of the Royal College of Nursing told ePolitix.com: "Alan Milburn is announcing what appears to be a 'pick and mix' approach to running the NHS in which it will be unclear who is in charge and accountable. This announcement is likely to lead to increased bureaucracy rather than streamlining alreadycomplex structures."

"The RCN questions whether the private sector has the necessary expertise to run large scale NHS hospitals, an area in which they have no previous experience. With the variety of providers suggested we need to have guarantees of quality, accountability, transparency and patient involvement. If such a fragmented approach does not deliver for patients, we would be concerned that the government could find itself tied into long-term contracts with the private sector and other organisations and would find it difficult to retain control over the NHS."

"At the moment the RCN is involved in the biggest UK negotiations on NHS pay and career modernisation in twenty years. This announcement seems to contradict the current status of these negotiations and could lead to a patchwork of different local pay, terms and conditions."

"We thought we had assurances that nurses providing care to patients in the NHS would remain employed by the NHS. Nurses and patients require some clear answers."

Forum Response: Royal College of Physicians

Professor Sir George Alberti, president of the Royal College of Physicians, told ePolitix.com: "We welcome many of the proposals in today's speech. The basis of the NHS is the need for good quality, timely clinical care with less inequities and inequalities than at present. To achieve that, we need clear guidelines to the Special Health Authorities who should be free to use a variety of means to run services. They must, however, reach and maintain national standards and tackle national priority areas. PCTs will require considerable guidance to prevent distortion of these goals."

"The issue for us is not so much who runs hospitals and Trusts, providing they are efficient, cost-effective and produce high quality care for patients. Physicians can have a much bigger role than at present in these processes."

"In the short-term, whatever management system we use there will continue to be problems while we build up the number of doctors, nurses, and other professionals, bed numbers and diagnostic and treatment facilities. There are no quick fixes!"

Forum Response: Unison

Dave Prentis, general secretary of Unison, told ePolitix.com: "This latest announcement is not a good idea. It is another case of the Department of Health being more concerned with a headline in a newspaper than reforming the NHS. It's just another diversion - policy-making on the hoof which is not based on any evidence."

"It's nonsensical to propose that hospitals which have become successful under the NHS should be pushed out to the private sector. Fragmenting the NHS won't improve patient care - look at what happened when the railway was broken up."

"What is needed is more money and investment going into the NHS and the staff who provide the services. The Health Secretary talks about freedom for managers. What does that freedom mean? Is it freedom to double their salaries at the patients' expense; freedom to drive down the pay and conditions of staff?"

"Mr. Milburn should hold his nerve and stick to the NHS plan. That plan deals with what to do with hospitals which don't meet standards."