Health sector regulator Monitor has been effective at helping trusts in difficulty to improve, the National Audit Office (NAO) believes.
A report released by the NAO found that although the role of regulating foundation trusts is becoming more challenging because of efficiency targets, Monitor has been effective.
Health sector regulator Monitor has been effective at helping trusts in difficulty to improve, the National Audit Office (NAO) believes.
A report released by the NAO found that although the role of regulating foundation trusts is becoming more challenging because of efficiency targets, Monitor has been effective.
However, the report did point out that Monitor's influence has been less effective where a trust’s problems are down to underlying issues in the local health economy, such as where commissioners are also in financial difficulty.
In recent months the regulator has changed how it intervenes in such cases, and has in some instances started working with commissioners, the local authority and the NHS Trust Development Authority to address these wider issues.
Staff at ‘case study’ trusts told the NAO that they took faster or more effective action, or both, because of Monitor’s interventions than they would otherwise have done.
The report highlights that Monitor has rigorous processes and standards, which it has adapted and strengthened, for assessing NHS trusts applying for foundation trust status.
Trusts are finding it more challenging to meet the standards Monitor applies during the assessment process, with only two trusts being authorised during 2012-13. At the end of December 2013, 147 trusts had attained foundation trust status, with 98 NHS trusts remaining.
Few NHS foundation trusts have got into difficulty soon after being authorised, indicating that Monitor’s assessment decisions have been sound.
Just three trusts have breached their regulatory conditions within 12 months of being authorised. Today’s report warns, however, that the growth in risk in the foundation trust sector may put unsustainable pressure on Monitor’s capacity to regulate trusts in difficulty or to maintain continuity of services. An all-time high of 25 trusts were in breach of their regulatory conditions at 31 December 2013.
Amyas Morse, head of the National Audit Office said: “Monitor has done a good job in regulating NHS foundation trusts. Its processes for assessing NHS trusts are robust and its judgments have mostly been sound. It has helped NHS foundation trusts in difficulty to improve and trusts have regularly taken radical action, such as changing their chair or chief executive, in response to Monitor’s interventions.However, bigger challenges lie ahead for Monitor, as it takes on its significant new responsibilities that stretch across the whole health sector.
"In addition, as Monitor itself recognises, it needs to adapt how it works with other bodies to tackle underlying local weaknesses that increase the risk of individual trusts failing, either clinically or financially.”
