Under the Single Oversight Framework, which was published by the watchdog yesterday, NHS trusts and NHS foundation trusts will be grouped in four segments. These are: providers with maximum autonomy; providers offered targeted support; providers receiving mandated support for significant concerns; and those in special measures.
NHS Improvement will provide support to trusts based on their classification, with those in the top tier being reviewed by the watchdog on a quarterly basis. Others will be examined on a monthly basis, but those in special measures may be reviewed weekly.
The framework has been published by NHS Improvement to reflect the merger of Monitor and NHS Trust Development Authority, and will replace Monitor’s Risk Assessment Framework and TDA’s Accountability Framework.
The new system is intended to allow for more tailored support for all hospital trusts, rather than the differing approaches of the previous frameworks, and allow for a more proactive approach to oversight and support for foundation trusts.
“We will be proactive in supporting trusts to improve their operation and financial performance for patients and the work published today supports that aim,” a spokesman for NHS Improvement said.
“There is widespread support among providers for this new approach, which will see us share good practice across the NHS and help providers to learn from each other.”
Although hospital trusts will be grouped under the new regime, it is not a ratings system for providers, the watchdog stated. The framework will help NHSI determine the level of support that providers need in relation to five themes: quality of care, finance and use of resources, operational performance, strategic change, and leadership and improvement capability.
On finance, NHSI highlighted that the assessments would now include an assessment of sector controls such as agency staffing costs. NHSI was now able to set out best practice on agency spending following the introduction of staff agency rules from last October, including price caps for all agency staff.
Benchmark information and guidance will be offered to all trusts as part of the universal support offer, while the targeted support offer will include help on specific areas, such as agency spend. Programmes will be agreed with providers, and will be voluntary.
Mandated support will be determined by NHS Improvement to address specific issues and help move the providers to a higher segment. Meanwhile, the special measures support will be for providers that have actually or are suspected to have breeched their licence. It and is intended to help minimise the time spent by a provider in this segment.
