Clare Elgie started her treatment at the Royal Hallamshire's renowned respiratory unit in Sheffield yesterday. By the time she finishes she may have something extra - a vote in the elections for the governing body that will replace Whitehall if the city's teaching hospitals become a foundation trust.

The prospect intrigues her, she said, but it needed some consideration.

That is exactly the view at trust headquarters. But there is beginning to be a gleam in the eyes of the chief executive, Andrew Cash, and his chairman, David Stone.

"Nothing is decided yet," said Mr Cash, whose board was initially sceptical. "But we have taken the first step, now we are waiting to see the details before deciding whether to put in a full application - provided we are shortlisted."

Mr Stone, who has long experience of Sheffield's buffeted local industry, added: "The devil is usually in the details."

But the board is now seeing angels in the foundation scheme, one of which is the freedom to involve local people and institutions. "We are more likely to know what we want at local rather than national level," said Mr Stone, whose medical colleagues are also keen to gain the freedom to set local targets.

Mr Cash said: "We know the specific problems we have here - for example, the average life expectancy on Sheffield's Manor estate, which is seven years shorter than in suburban Hallam. If we can deal with problems like that, we will be meeting - beating - national targets by default."

Foundation status could also enhance the flexibility which gave the Hallamshire and its four linked hospitals three-star status. The board want to build on those reforms which have shrunk the NHS's official staff gradings from 140 to 15 key bands.

Votes for patients also chime with the trust's belief in carrying the entire south Yorkshire health system with it into the three-star category. Mr Stone and Mr Cash hit on a comparison suiting the old "socialist republic" tradition of south Yorkshire. "It's like the Co-op," they said.