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I think the idea when TDA and Monitor formed was that Monitor would have all the high functioning self-governing Foundation Trusts and could apply a light touch. Meanwhile TDA would be in charge of shutting down / hiving off failing organisations to the private sector and within 5 years it would shut as all NHS would be FT.

Mid-Staffs was a FT. Therefore being an FT is not guarantee against failure, so Monitor cannot have a light touch. A lot of the TDA governed institutions will never achieve FT status, yet there is no political appetite for selling them off/ letting them get taken over. This chain idea works if a partnership of equals, otherwise resources just get sucked out of the small hospital.

If Monitor takes over TDA, it will have to regionalise and provide strategic support. I wonder what we should call these entities? I like the term 'Strategic Monitor Authority'' or 'Regional Monitor Authority'.

It's been great having all these clever McKinsey people in the NHS. They have really shaken it up.