Who could be against foundation hospitals? The new hospitals, as set out by ministers, are at first sight a progressive's dream. They resurrect the old cooperative or mutual society idea, creating a new system of hospitals that will be free from Whitehall's dreaded central controls. They will be able to raise extra capital, retain surpluses and introduce new pay incentives. Membership will be drawn from local communities, with the right to elect a board and own the organisation. There will be a lock on assets so that they cannot be demutualised. They will remain part of the NHS, retain genuine public ownership, but offer greater local accountability and greater emphasis on local service. In a sentence they offer a 3D service: more devolved, diverse and democratic. Yesterday, the health secretary announced 32 out of the top 51 hospital trusts that are eligible for foundation status have applied, and all 300 could qualify within five years. Yet the number of Labour MPs signing a Commons motion expressing concern over the super-hospitals has risen to 116.

MPs are right to be concerned. The first reason why they are right is the confused and contradictory turn ministers are taking in health policy. They have only just set up 400 primary care trusts (PCTs), designed to involve people closest to patients, GPs and primary health workers, to gauge local health needs, and then commission appropriate hospital provision. Now some rights on deciding provision are being restored to foundation hospitals, when ministers are supposed to be committed to creating a primary care-led system. The NHS is a health, not a hospital, service. Nine out of 10 people who turn to it never get to hospital. The biggest new challenge facing health systems - chronic diseases that cannot be cured but can be managed with proper care - requires the more integrated primary and hospital care that PCTs can encourage. Strong independent hospitals are a shift in the wrong direction. The old silo days are over.

Worse still, the plan to give local people a vote on who sits on the new boards will give foundation hospitals a legitimacy that PCTs do not enjoy. The Tories made the same mistake, giving providers more status and commissioners less clout. Surely, it is the PCTs that are there to decide what is required that need democratic legitimacy, not the provider. The governance of the new hospitals is a real mess, including the risk of the boards being captured by a determined patient lobby group. Their localism is also open to question. Some hospital trusts run as many as six hospitals. Several serve more than one town with quite separate needs. Then there is the two-tier issue, rightly raised by Labour MPs, many of whom see their local hospital threatened by a super-hospital in the next door town, able to lure the best nurses and doctors with better pay.

Ministers made a serious mistake in proposing that only the already well provided, the three star hospitals, are eligible for foundation status. The idea that all 300 hospital trusts could be given foundation status within five years is unbelievable. Yet even if they were, the gap between the best and the worst would have widened unacceptably. Rather than pushing for yet another restructuring, diverting managers from the admirable goals in the government's 10-year plan, a much more modest pilot scheme should be tested. There has been too much NHS-wide reform. It needs more stability. The current plan has the smell of a Downing Street move to pre-empt the Tories. It is a thinktank idea, retrofitted with modish aims like diversity and devolution.