By Vivienne Russell | 26 February 2013
Monitor has been a rigorous and effective regulator for the health service but may struggle to maintain this with more foundation trusts at financial risk, the National Audit Office said today.
In a largely positive report, the watchdog said Monitor had achieved value for money and raised the bar for the standards expected of trusts applying for foundation status.
Monitor’s interventions were also found to be effective, particularly when a trust’s underlying issues were internal such as poor leadership or financial management. However, the NAO said Monitor’s influence was less effective when problems arose from underlying issues in the local health economy or where commissioners were in financial trouble.
The report also warned that, with more foundations trusts facing governance and financial risk, ‘unsustainable pressure’ could be placed on Monitor’s capacity to regulate trusts in difficulty or to maintain continuity of service.
‘At December 31 2013, 25 NHS foundation trusts were in breach of their regulatory conditions, an all-time high,’ the report noted.
‘The enhanced monitoring and intervention that these trusts require takes an increasing amount of Monitor’s resources.’
Auditor general Amyas Morse said Monitor had done a ‘good job’ regulating foundation trusts.
‘Its processes for assessing NHS trusts are robust and its judgements have mostly been sound,’ he said.
‘However, bigger challenges lie ahead for Monitor, as it takes on 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.’
