UK's health secretary has said that the NHS managers who fail to meet the deadline to prepare hospitals to become foundation trusts by 2014 will be "removed and replaced" from their positions.

Andrew Lansley adopted a tougher stance indicating a new approach to the health services. He said that he was written to all the remaining NHS trusts and have reached agreements on when they would be "clinically and financially sustainable" so that the foundation status could be granted.

The Department of Health has expressed concerns over the time taken by the remaining 69 hospitals in the NHS to become foundation trusts. The foundation trusts work outside Whitehall's control and are the main components of Lansley's reforms. The foundation trusts are to compete in clinical and financial terms for patients.

The National Audit Office has said that the number of authorizations were at their heights in 2007 and 2008 but only 14 foundation trusts statuses have been given since the end of 2009.

"Sometimes, the problem rests with a hospital's management team - unable to take the difficult decisions needed to turn things around. For them, I have a stark warning. If your hospitals are not there by the time you say, you're not getting there at all," Lansley said.

"The secretary of state has the power to remove and replace management teams that fail to deliver, and I will not hesitate to use that power if needed," he added.