Exclusive: Monitor interventions double in response to Francis

Enforcement action has been taken on 21 occasions in the first 10 months of this year, compared to just nine instances in the whole of 2012-13.

Monitor licences foundation trusts and uses its enforcement powers when trusts breach or are suspected to be in breach of their licence.

Where Monitor took regulatory action against the same provider on different occasions over the year, HSJ classed these as separate actions.

In the year to date, Monitor has formally intervened in 16 foundation trusts, whereas in 2012-13 it announced regulatory action against just eight.

Speaking to HSJ last week, Monitor chief executive David Bennett admitted the regulator’s “arm’s length” distance from foundation trusts had become “a little shorter” as it intervened more readily.

He said increased monitoring and intervention was explained by “a declined appetite for risk” among “Parliament, the government and the public”.

Saffron Cordery, director of policy and strategy at the Foundation Trust Network, said a “Francis effect” was one of the reasons Monitor “isn’t giving trusts the latitude it might have given them previously”.

The doubling of enforcement actions occurred after the publication of the Francis report in February last year. This identified how a failure of regulatory oversight had contributed to the scandal of poor care at Mid Staffordshire Foundation Trust.

Six of the foundation trusts subject to actions were placed in “special measures” following the Keogh review of hospitals with high mortality rates, which was conducted in response to the Francis report.

Concerns from the Care Quality Commission led to regulatory action at a further six trusts this year. Accident and emergency underperformance has been cited in four cases so far in 2013-14, compared to five last year.

Financial problems featured more prominently as a reason for action in 2012-13 than they have done so far this year. Poor financial performance featured as a reason for Monitor taking action at a trust in five instances in 2012-13, whereas this year it has only been cited in two cases.

Ms Cordery said that trusts had “definitely noticed… increased activity from the regulators”, and that while the focus on rooting out failings in care was to be applauded, it was important that intervention was “proportionate and risk based”.

Chris Bown, chief executive of Poole Hospital Foundation Trust, which is under investigation by Monitor because of financial sustainability concerns, said the increase in intervention reflected “the enormous pressure that the sector is under both financially and in meeting ever increasing − quite rightly − quality standards”.

He said that while “Monitor don’t take regulatory action unless they really have to”, the sector should not just look to the regulator, and boards needed to take responsibility for exposing and responding to potential failures.

Mr Bown said Monitor had been “completely reasonable” in its investigation into Poole.

In 2012-13, all of the eight providers that Monitor took action against were acute providers, whereas in 2013-14 the regulator also intervened at three providers of mental health services: Dorset Healthcare University, Calderstones Partnership and Cumbria Partnership foundation trusts.

In addition to its regulatory actions, Monitor has also announced investigations into 15 foundation trusts in the year to date

Stephen Hay, Monitor’s managing director of provider regulation, said the regulator had “revised our regulatory approach to ensure we spot trusts at risk of breaching their licence”.

He said it was to be expected that the number of actions would have risen, due to financial pressures hitting the NHS and the CQC’s overhauled inspection regime.

To compile the figures, HSJ recorded each time Monitor publicly announced it was taking action against trusts.

The regulatory framework in which foundation trusts operate changed in April 2013, and so to ensure accurate comparison between the two years certain types of action were excluded from the figures. For example, this year Monitor announced when it was investigating trusts because of a suspected breach of their licence. Because this was not the case in previous years, these investigations have been excluded from HSJ’s headline figure.