The quest of Oxfordshire’s main hospital trust to secure foundation status has gone on for so long that some readers may have forgotten what the actual point is.

Others, understandably, may well have wrongly supposed that Oxford University Hospitals NHS Trust already enjoyed this hallmark of excellence in the health service.

It is linked to Oxford University, for goodness sake, and Oxfordshire Health Trust became an NHS Foundation Trust as long ago as April 2008.

But no: the striving, inspections and assessments continue but there is now real hope that OUH could secure trust status by the beginning of the new financial year. To be fair, it is now far harder to clear all the hurdles and meet the necessary targets than it had been for the first wave of applicants.

OUH chief executive, Sir Jonathan Michael, believes success will give local people a far greater say in the running of hospitals and the trust considerable financial freedom, with greater opportunity to borrow and form partnerships with other trusts, the voluntary sector and even providers of social housing for staff. But interestingly, with the prize now within reach, a report from the health regulator Monitor has just revealed that many foundation trusts are struggling, with many reporting deficits for the first time.

Ultimately, greater demands on hospital services, increasing numbers of patients, problems recruiting and retaining staff and uncertainty about long-term funding will shape the quality of services provided at the John Radcliffe, Churchill, the Nuffield Orthopaedic Centre and the Horton Hospital in Banbury. Foundation hospitals are in no way free of the dangerous level of pressure building up across the whole system, pressure which will put the NHS — if not the foundation status — at the centre of next year’s General Election campaigning.