The Editor, Sir:

In view of Prime Minister Bruce Golding's strong views on community development and of his commitment to the Local Govern-ment Reform Programme which has as its major objective the involvement of local communities; and, in addition, the limited funds we have as a nation to spend on health services; the implementation of a hybrid of the British Hospital Foundation Trust across Jamaica, starting in the parish capitals, could be a policy initiative that could bring serious benefits to local communities.

Local communities and staff would be given a bigger say in managing hospital services in their area.

Trusts will establish stronger connections between local hospitals and their local communities. Local communities will have social ownership of their foundation trust. Those living in communities served by a hospital of a foundation trust will be invited to become a member. The membership community of each foundation trust will be made up of local people, patients and carers and staff.

Public ownership

Members will be able to stand and vote in elections for Governors of the Trust. Governors will be responsible for representing the interests of the members and partner organisations in the local health economy in the governance of the foundation trust. This sort of public ownership and accountability will ensure hospital services more accurately reflect the needs and expectations of local people.

Foundation trusts will not work in isolation. They will be bound in law to work closely with partner organisations in their local area. Health care planning will continue to involve the whole National Health Service community, but with more freedom to set up partnerships between all health care providers.

Accountability framework

Foundation trusts will operate within a clear accountability framework. They will not be left to sink or swim, allowed to 'cherry pick' services or set loose to pursue organisational goals at the expense of the needs of their local health community.

The achievement of the Mille-nnium Development Goals is of prime importance, their achievement means improving the health and quality of life of the poor, which is a fundamental goal of economic development. While there have been achievements, differences and disparities exist between countries, and several are lagging behind, this region is one of the most affected by the HIV/AIDS pandemic; and there has been a resurgence of tuberculosis and a rise in obesity and non-communicable diseases such as diabetes and hypertension. For Jamaica to become a developed country we need to address these problems. The establishment of Hospital Foundation Trusts in Jamaica must be a step in the right direction, policy wise.

I am, etc.,

CHARLES DEMONTAQUE

Phd

Stafford University

c/o 101 Weybrige Road

Addlestone Road, Surrey

United Kingdom