Alan Milburn has loosened up central government power over the health service's top performers, saying "the challenge is to free the best NHS hospitals from direct Whitehall control".

Forum Response: Unison

Karen Jenning's, Unison's national secretary for health, told ePolitix.com: "We are pleased to see that the government has dropped the idea of getting private companies in to run foundation hospitals and they are to remain firmly in the NHS family. However at the same time as creating 'foundation' hospitals, you run the risk of creating a poor relation in the surrounding trusts.

"Patients who are not treated in foundation hospitals will believe that they are getting a second rate service. The morale of hard working staff in hospitals that don't achieve this status will be badly undermined. And many nurses will be tempted to move to foundation hospitals and exacerbate recruitment and retention problems in the surrounding areas.

"The government needs to raise standards across the whole of the NHS. Instead of setting hospital against hospital, they need to foster a climate of co-operation, so that best practice is shared across the NHS for the benefit of all".

Forum Response: Royal College of Nursing

Dr Beverly Malone, general secretary of the Royal College of Nursing, told ePolitix.com: "The RCN believes that decentralisation of the NHS is an essential step in improving the health service. By devolving power to NHS Trusts and by involving the local community, we believe that standards of care will be raised. However today's proposals to free the Foundation Trusts from Whitehall control leave us with considerable concerns.

"Star ratings are given to hospitals which successfully meet government targets, such as reducing waiting lists, but these Trusts are not necessarily those achieving higher standards of patient care. The RCN is concerned that releasing Foundation Trusts, which have achieved three star rating, from government control is based on an inadequate system of assessment which may not benefit patients.

"These new proposals are in danger of fragmenting the delivery of care. We need an NHS which is working in partnership with all its components, as well as the independent and voluntary sector. These recommendations could undermine collaboration which is essential within the NHS and may lead to inequity of care on a national and regional basis. We could be creating a creating a multi-tiered system which will strike at the principles of the equality of access to treatment.

"Alan Milburn speaks of the Foundation Trusts using the flexibility of the new pay system in negotiation. The RCN has had assurances from the government that the pay modernisation system currently being developed will apply to all NHS organisations including Foundation Hospitals. Any suggestion of local flexibility in pay and rewards for staff must be within the national framework to prevent against greater inequity amongst staff.

"Although the RCN welcomes the government's move towards decentralisation, we are concerned that creating hospitals freed of governmental control could in the long-run undermine the basic principles of the NHS which we look to the government to safeguard."