Governance concerns raised about foundation trusts

28 Sep 11
The proportion of NHS foundation trusts with governance problems leapt by 58% this spring, regulator Monitor has said.

By Mark Smulian | 29 September 2011

The proportion of NHS foundation trusts with governance problems leapt by 58% this spring, regulator Monitor has said.

Its report on the first quarter of 2011/12, published today, showed that 58 trusts had red or amber/red ratings for governance, against 36 in the final quarter of 2010/11.

The other 79 trust received ‘green’ or ‘amber/green’ ratings.

Monitor’s report said the main reason for the governance concerns was failure to comply with Care Quality Commission requirements.

Chief operating officer Stephen Hay said: ‘We automatically reflect CQC concerns in our own risk ratings and expect foundation trusts to take action quickly to address the issues.

‘We are calling in more foundation trusts to find out how serious the concerns are and what they are doing to address them. Where there is evidence that CQC issues are not being resolved quickly, we will consider more formal regulatory action.’

The CQC has only been inspecting foundation trusts for the past 18 months, and does so in response to specific concerns.

Monitor said this meant that in this initial period ‘outcomes across the NHS as a whole are initially likely to show disproportionately high levels of non-compliance’, but said the number with poor governance risk ratings was ‘greater than planned’.

Ten trusts were judged to be in ‘significant breach’ of requirements, a status that can be the prelude to intervention.

Monitor found that financially the foundation trust sector was performing slightly ahead of plan. Operating income at trusts was £8.3bn, some £58m above that planned, but total operating costs were also £36m higher than planned at £7.9bn.

Hay said: ‘It’s encouraging that the sector is in overall surplus and ahead of plan for the first quarter – although surpluses are lower than last year due to the economic environment.

‘But there are a number of foundation trusts that are beginning to struggle and we are looking closely at these and taking regulatory action in several cases to make sure that the issues are addressed.’

Mike Farrar, chief executive of the NHS Confederation, said the greatest problem facing the sector was the need to find £20bn of efficiency savings by 2015. He warned that service standards would fall.

‘We are coping with a flat budget while demand for services is increasing at above the rate of inflation due to an ageing population and increasing technology costs,’ he said.

‘NHS chief executives and chairs say they expect patient access, including waiting times, to deteriorate over the next year, and some have warned that quality of care could suffer as a result of financial pressures.’

Sue Slipman, chief executive of the Foundation Trust Network, said her members were near to meeting target efficiencies, but had to handle ‘further blows to their financial sustainability’, with penalties imposed for patients readmitted within 30 days of discharge likely to total £470m in England.

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