title: Increasing autonomy in publically owned services.
abstract: OBJECTIVE
  The purpose of this paper is to explore government efforts to enhance the autonomy of community health services (CHS) in England through the creation of Foundation Trusts status. It considers why some CHS elected to become nascent Community Foundation Trusts (CFTs) while others had not and what advantages they thought increased levels of autonomy offered.
  
  
  METHODS
  Data are drawn from the evaluation of the Department of Health's CFT pilot programme. Participants were purposively selected from pilot sites, as well as from comparator non-pilot organisations. A total of 44 staff from 14 organisations were interviewed.
  
  
  RESULTS
  The data reveals that regardless of the different pathways that organisations were on, they all shared the same goal, a desire for greater autonomy, but specifically within the NHS. Additionally, irrespective of their organisational form most organisations were considering an almost identical set of initiatives as a means to improve service delivery and productivity.
  
  
  CONCLUSIONS
  Despite the expectations of policy makers no CFTs were established during the course of the study, so it is not possible to find out what the effect of such changes were. Nevertheless, the authors were able to investigate the attitudes of all the providers of CHS to the plans to increase their managerial autonomy, whether simply by separating from PCTs or by becoming CFTs.
  
  
  CONCLUSIONS
  As no CFTs have yet been formed, this study provides the only evidence to date about increasing autonomy for CHS in England.
authors.affiliation: School for Policy Studies, University of Bristol, Bristol, UK.
authors.forename: Ailsa
authors.initials: A
authors.lastname: Cameron
authors.forename: Pauline
authors.initials: P
authors.lastname: Allen
authors.forename: Lorraine
authors.initials: L
authors.lastname: Williams
authors.forename: Mary Alison
authors.initials: MA
authors.lastname: Durand
authors.forename: Will
authors.initials: W
authors.lastname: Bartlett
authors.forename: Virginie
authors.initials: V
authors.lastname: Perotin
authors.forename: Andrew
authors.initials: A
authors.lastname: Hutchings
mesh_terms: D003153:Community Health Services / Q000191:economics / Q000458:organization & administration* / Q000639:trends; D003363:Cost Control / Q000379:methods / Q000592:standards; D004739:England; D006801:Humans; D017009:Professional Autonomy; D013222:State Medicine / Q000191:economics / Q000458:organization & administration* / Q000639:trends
keywords: Autonomy; Community nursing; Marketization; National health service