• Anna Dixon, John Storey, and Arturo Alvarez Rosete.
• The King's Fund, London W1G 0AN, UK. a.dixon@kingsfund.org.uk
• J Health Serv Res Policy. 2010 Apr 1; 15 (2): 82-9.

ObjectivesTo map and describe the formal accountability relationships of foundation trusts in England and to explore the interpretations of these relationships by the key actors.MethodsDocumentary analysis and interviews with chief executives, chairs, directors and governors in six acute trusts and two Strategic Health Authorities.ResultsAlthough vertical accountability to the Department of Health (via Strategic Health Authorities) has, in formal terms, been removed some foundation trusts continue to be held to accountability by Strategic Health Authorities, albeit informally. Directors of foundation trusts perceive strong accountable to their regulator, Monitor, particularly for financial performance, but there is some confusion about where accountability for quality of care rests. Horizontal lines of accountability to the local population (through Local Involvement Networks and local government Overview and Scrutiny Committees) remain weak.ConclusionsContrary to the major policy objectives of giving greater autonomy to foundation trusts and making them more accountable to the local population, they continue to look towards the Department of Health rather than to the local population and its representatives. The accountability of foundation trusts needs to be simplified, clarified and strengthened.

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