Health Correspondent Barry Nelson talks to the health boss who is likely to head one of the first foundation hospitals in the region.

OPPOSITION to foundation hospitals is showing no signs of going away if the recent Labour Party conference is anything to judge by. The Government's defeat by a grassroots revolt provoked acres of comment in the press. But the reality is that the objections of trade unions and Labour backbenchers is likely to be ignored by a Government determined to modernise the NHS and win a third term of office..

Joan Rogers, chief executive of North Tees and Hartlepool NHS Trust, will soon head one of the North-East's first foundation hospitals if all goes according to plan. The highly-regarded and experienced administrator is clearly relishing the prospect of being in the vanguard.

Joan starts off by insisting that her own staff appear to like the idea of becoming one of the first foundation hospitals. "They like the idea of the prestige and the status. They feel good about having this kite mark," but she concedes that people who live in the trust's catchment area may be puzzled about the whole process.

"They are distressed by the idea that there may be a two-tier system of health care, although we still have a two-tier system because different areas of the country still have different amounts of health spending. The North-East, by and large, has less funding than some other areas," says Joan, who gives credit to the Government for trying to iron out these differences.

Rather than encouraging inequalities, Joan argues that the changes planned by the Government - including the creation of more and more foundation hospitals with greater freedoms to borrow money - will tend to increase health services in areas which have been losing out.

"In future, primary care trusts are going to be encouraged to buy from private sector providers as well as public sector providers to get the best for their local patients. They will want to buy uniformly equal services for all their patients and to get everyone up to speed," she adds.

"The PCTs will dictate what happens. If you are no good, either as a three star or ordinary trust, they are going to be able to send patients elsewhere, including the new privately run diagnostic and treatment centres," she says.

This is not popular with the trade unions, because it no longer gives the public sector the automatic dominance it has had in the past.

"Services will remain free to patients at the point of delivery but the message, as Health Secretary John Reid put it, is that they are not prepared to shore up 'crappy old hospitals' out of hard-earned tax-payers' money. So if you are good, the PCTs will be delighted to keep giving you a contract," says Joan.

Some critics argue that the NHS simply needs more money rather than another rejig, but Jean argues that the extra cash is already flowing and what is needed is some way of galvanising the NHS so hospitals raise their game uniformly.

The secret may be the C word - Competition. Joan points to what has been achieved in London when NHS trusts were faced with losing patients to new private treatment centres. "They suddenly all managed to hit the six-month waiting time target because they didn't want to lose the work. This is what the Government sees the market doing," she says. Because the Government has set such ambitious targets - no patient waiting longer than three months by 2008 - Joan argues that major changes are needed, either to allow existing NHS hospitals to grow or invite private diagnostic and treatment centres to spring up where they are needed.

Looking at her own situation, Joan believes that North Tees and Hartlepool will not be able to hit the three-month target in five years time without changes. "I am going to have to get something extra, either a DTC run by a friendly local company - which I have no problem with - or I build extra operating theatres and bed blocks by borrowing," she says.

She points to a pilot scheme in Bradford where a conventional NHS hospital is working in partnership with a neighbouring private DTC.

"In order to hit a six-month maximum waiting time target early they have a DTC next door. As far as I know it is working well and the Bradford hospital is still going like the clappers," she adds.

She says the changes advocated by the Government "are about gingering up the Health Service through competition - but more than any thing else it is about getting extra capacity to treat more NHS patients."

With the trust currently going through a period of public consultation about becoming a foundation hospital, Joan looks forward to the time when staff and local residents join senior managers for board meetings. She believes this will help to focus health care spending on where local people feel it is needed. "For example, it might be decided to focus more resources on tackling drug problems and less elsewhere," she says.

All in all, despite gloom and doom from opponents of foundation hospitals, the North Tees and Hartlepool boss believes that the changes will be beneficial and less radical than everyone seems to think.

"I think patients are going to see a lot more of the same," she says.