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Quarter of FTs face regulatory intervention

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Nearly a quarter of all foundation trusts are in breach of their licence, analysis by LGC’s sister title Health Service Journal has revealed.

  • Monitor taking enforcement action against 36 FTs
  • Ten more being investigated over finances or performance
  • FT chief concerned over level of intervention


The analysis shows that Monitor is taking enforcement action against 24% of FTs for breaching their licences. There are 151 trusts with foundation status.

There are now 36 FTs facing regulatory intervention. A further 10 are being investigated by Monitor over finance or performance concerns.

At the end of 2014-15, 29 FTs (19%) were in breach of their licence. This was up from 27 in breach in 2013-14.

The majority of FTs are in breach of their licence because of poor finances. Several trusts now comply with standards in areas such as governance and accident and emergency waiting times, but their financial concerns remain.

HSJ analysis in January last year found that Monitor intervened at 16 FTs in 2013-14, doubling from the previous year.

The chief executive of an FT in breach of its licence for financial reasons told HSJ: “There is a huge amount of intervention. I don’t know how much longer this can go on. There will not be enough [improvement directors] to go around.”

They said the majority of problems stem from a shortage of money and providers would have to make decisions about what services can be offered if extra money is not available.

They gave the example of a critical care unit, which requires a certain number of staff and space within the hospital to meet care quality standards. They said: “The tariff doesn’t even cover the standard. So before you even start providing those services you’ve got all your capital costs, your equipment costs, your depreciation. The tariff for that patient, it doesn’t cover the contribution the service has to make to the bottom line.

“People are going to have to think very differently about how they run hospitals if that cash isn’t available.”

However, they said Monitor’s interventions may help whole health systems to have honest conversations about the problems they are facing.

The chief executive said: “I’m pleased that Monitor’s recognised that our system is broken. In some respects it does help the more intractable problems to get a spotlight on the rest of the system.”

Miriam Deakin, head of policy for NHS Providers, said: “While foundation trusts can be in breach of their licence for issues relating to governance or financial management, there’s no doubt that the increase in regulatory activity reflects the scale of financial and operational challenge facing the NHS in 2015-16.

“Two-thirds of NHS providers are forecasting a deficit for this financial year, including a significant number of trusts that have been rated as well led.

“This level of financial distress is caused by a mismatch between the demands placed on the service and the resources the NHS has been given, rather than a problem created by individual providers or their partners, in isolation. Increased regulatory focus on NHS providers alone simply adds undue burden to the frontline without solving the problem. More recently, we welcome the focus from the arm’s-length bodies on exploring greater support at local health economy levels.”

A Monitor spokesman said: “The NHS is facing an almost unprecedented financial challenge. We expect foundation trusts to leave no stone unturned in efforts to make the money we have go as far as possible.

“However, we do recognise that we also need to support individual foundation trusts as they strive to provide quality services on a sustainable basis, which is why we’re setting up our provider sustainability team. This will help them to improve and help us to avoid the need for formal regulatory action.”

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