It will have been hard to escape the fact that this week marks the 60th anniversary of the NHS, but another health service milestone is being celebrated in Westminster today.

From this morning, Pennine Care NHS Foundation Trust becomes the 100th NHS trust to achieve foundation status, having passed the rigorous appraisal process conducted by Monitor, the independent watchdog that regulates these flagship hospitals.

Annointed with a special status that confers financial and administrative autonomy, foundation trusts (FTs) were a Blairite - and initially controversial - innovation, designed to give greater freedom to NHS organisations.

Gordon Brown was among members of the Labour Party who were initially sceptical of the policy, but he later became convinced that hospitals would benefit from behaving more like independent businesses. Many FTs have since become synonymous with high-quality care and financial management. But Bill Moyes, the chief executive of Monitor, is not in jubilant mood.

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“If you'd asked me in January 2004 how long it would take for us to approve our 100th foundation trust ... well, I'm incredibly surprised and disappointed that it's taken so long,” he says.

“I would have liked to have had at least two thirds of hospital trusts achieving that status by now.” There are good reasons why it hasn't happened, he says, including that “I don't think anyone realised how bad the hospital system was when we started. We found ... that the boards, particularly the non-executive directors, were not that strong.”

Monitor employs 90 staff in its London offices, mostly, like Moyes, with extensive economic or business experience. This makes the watchdog a strict examiner, turning down one bid in three for FT status.

“We just ask two things: that trusts be financially viable in the short and long-term ... and also that they are well- governed, according to performance on national targets and standards - or if not, they understand what their problems are.”

Moyes bemoans the degree of government interference in typical NHS trusts. “We've had 60 years of politicians effectively running many aspects of what happens in hospital settings.”

But aspects of foundation status have aroused criticism, including an apparent loophole that allows FTs to avoid the cap on the number of private patients that they can treat.

The watchdog has responded by launching a consultation that Moyes hopes will set out the complex arguments surrounding the row.

Although he believes in the power of the internal market, he is adamant that care should remain free at the point of need. “Before the NHS, my mother's sister died of meningitis when she was 9 because the family could not afford the treatment - it is a principle that shouldn't be contested lightly,” he says.

After Lord Darzi of Denham's Next Stage Review, published this week, a lot of focus within the health service will be on commissioning - where NHS authorities focus on addressing local health inequalities and priorities, and spend their budgets more effectively - but the concept is at a crossroads, he argues. “There are expectations of quick fixes, but this will take time.”

Meanwhile, anyone running a hospital needs to have appropriate experience, he says. “I think we have some great managers in the NHS, but all those chief executives, financial directors and clinical directors are not properly held to account if you don't have qualified non-executive directors sitting on your board.”

Born: September 18, 1949, Dundee

CV: Chemistry Phd, Edinburgh University; joined Civil Service, 1974; Cabinet Office economic secretariat, 1980; Scottish Office as director of performance management, NHS Scotland, 1983; director-general of the British Retail Consortium, 2000; joined Monitor as founding chief executive in 2004.

What he says: “We do not see the NHS as an organisation, we see it as the commissioning part. We think the Government is right to create hospitals that are free-standing in their own right.”

Little-known fact: As a restaurant reviewer, he was known for his prodigious “Edwardian appetite”.

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