Joan Rogers, boss of one of the region's contenders for foundation hospital status, talks to Barry Nelson.

WITH the controversy about foundation hospitals still raging, most NHS trust chief executives are keeping their heads down.

A backbench rebellion by Labour MPs may or may not have disturbed the composure of Health Secretary Alan Milburn this week but at least one North-East hospital boss is willing to share her vision for the future.

Joan Rogers, chief executive at one of the region's contenders to become a first wave foundation hospital trust - North Tees and Hartlepool NHS Trust - can see positive advantages in the latest Health Service reforms.

"For me, having community governors is a big deal. They will drive forward foundation hospitals, exactly like governors at schools and housing associations have," says Joan.

The 350,000 people served by Joan's split-site hospital trust are already extremely generous when it comes to supporting their local NHS hospital.

But Joan believes that by putting local residents and staff on a community-based board of directors, the trust will forge an even closer relationship with the towns they serve.

"Local people are incredibly generous already, they give something like £2 per head to the trust every year. If we were to build on our new relationship with the public, establish charitable trusts, set up joint ventures with local companies we could do so much more," she adds.

It is this aspect of foundation hospitals which attracts Joan more than any other.

While much has been made of foundation hospitals having an unfair advantage over other local hospitals, being able to poach staff and build new facilities, Joan believes the re-connection with local communities is the crucial thing, combined with greater freedom to do things slightly differently.

"In ten years time you might decide you would rather let a three-month waiting time on something float to six months and the money saved could be used for something which is a locally agreed priority."

Joan points to the "massive problems" caused by drug abuse in Stockton and Hartlepool as a "big, big issue" which could be tackled by diverting resources from other less urgent areas.

"It could be that we would make a choice to use money raised from charity, from some internal cost improvement, from primary care trust or even a joint venture to invest in these services for drug users," says Joan.

Quite small sums could start some big things rolling, the chief executive argues. Joan is relaxed about tensions developing between foundation hospitals and the rest. "I have no intention of competing with other hospitals, we had all of that bad excess in the 1990s. In the end, we all got together and said all this competition was harmful," she says. "We have a duty of partnership with the rest of the NHS which will stay. Even if we went into receivership, we would stay within the health service," she adds.

Despite finger-pointing in some quarters about foundation hospitals forming a new elite Joan says that inequalities are not new in the NHS.

"Foundation hospitals will be advantaged for a while but to be blunt, that is happening now. Some trusts got diagnostic and treatment centres this year, in particular South Durham, and we didn't. We got an extra £1m for being a three star hospital."

But Joan argues that it won't be "mercurial things" like being able to borrow money more easily but the "staying power of community governors" that will make them a success.

Joan says the trust will still have to meet national targets and be tightly regulated but foundation status should give the hospitals some freedom to be a bit more creative, "so we can say one size does not fit all, we don't want to do that, we want to do this."