THE region's only Foundation Trust hospital - City Hospitals Sunderland - could be joined by four more.

Health Secretary John Reid yesterday confirmed his support for 20 more hospitals to become NHS Foundation Trusts, including four in the North-East.

The contenders, Newcastle Hospitals (which may include the Royal Victoria Infirmary, The Freeman Hospital and Newcastle General Hospital), Gateshead, South Tyneside and Harrogate, could become foundation trusts as early as November 1 or February 1 next year.

Most of the these trusts were on course to become foundation hospitals after consistently winning the maximum three stars in the annual hospital ratings.

But the Newcastle trust, the biggest in the region, has only just been awarded three stars in the last allocation after being demoted to two stars the previous year.

Foundation hospitals are able to borrow extra cash and set different pay rates, with decisions taken by a board elected by the public.

The North Tees and Hartlepool NHS Trust missed its chance to win greater independence in April after failing to put together its business plan on time.