Monitor was an executive
non-departmental public body
In the United Kingdom, non-departmental public body (NDPB) is a classification applied by the Cabinet Office, Treasury, the Scottish Government and the Northern Ireland Executive to public sector organisations that have a role in the process of n ...
of the
Department of Health
A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their ow ...
, responsible between 2004 and 2016 for ensuring healthcare provision in
NHS England
NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...
was financially effective. It was the sector regulator for health services in England. Its chief executive was Ian Dalton and it was chaired by
Dido Harding
Diana Mary "Dido" Harding, Baroness Harding of Winscombe (born 9 November 1967), is a British businesswoman and Conservative life peer. She served as chairwoman of NHS Improvement from 2017, and from May 2020 to April 2021, during the COVID-19 ...
. Monitor was merged with the
NHS Trust Development Authority
The NHS Trust Development Authority (NHSTDA) was an executive non-departmental public body of the Department of Health. Its formation came as a result of reorganisation of the National Health Service (NHS) in England outlined in the Health and Soci ...
to form
NHS Improvement
NHS Improvement (NHSI) was a non-departmental body in England, responsible for overseeing the National Health Service's foundation trusts and NHS trusts, as well as independent providers that provide NHS-funded care. It supported providers t ...
on 1 April 2016.
History
The body was established on 5 January 2004 under the
Health and Social Care (Community Health and Standards) Act 2003, and was formally called The Independent Regulator for Foundation Trusts. The legislation made it responsible for authorising, monitoring and regulating NHS
foundation trust
A foundation trust is a semi-autonomous organisational unit within the National Health Service in England. They have a degree of independence from the Department of Health and Social Care (and, until the abolition of SHAs in 2013, their local s ...
s. It took on the brand name Monitor from August 2004
The
Health and Social Care Act 2012
The Health and Social Care Act 2012c 7 is an act of the Parliament of the United Kingdom. It provided for the most extensive reorganisation of the structure of the National Health Service in England to date.'' BMJ'', 2011; 342:d408Dr Lansley's M ...
formally changed the organisation's name to Monitor and gave it additional duties.
In addition to assessing NHS trusts for foundation trust status and ensuring that foundation trusts are well led, in terms of quality and finances, Monitor had a duty to:
* set prices for NHS-funded care in partnership with
NHS England
NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...
;
* enable
integrated care;
* safeguard
patient choice
Patient choice is a concept introduced into the NHS in England. Most patients are supposed to be able to choose the clinician whom they want to provide them with healthcare and that money to pay for the service should follow their choice. Before ...
and prevent anti-competitive behaviour which is against the interests of patients; and
* support commissioners to protect essential health care services for patients if a provider gets into financial difficulties.
Monitor's main tool for carrying out these functions was the NHS provider licence, which contains obligations for providers of NHS services. The 2012 Act requires everyone who provides an NHS health care service to hold a licence unless they are exempt under regulations made by the Department of Health. Foundation trusts were licensed from 1 April 2013, and all other non-exempt providers were required to apply for a licence from April 2014.
It was announced in June 2015 that the chief executive posts at Monitor and the
NHS Trust Development Authority
The NHS Trust Development Authority (NHSTDA) was an executive non-departmental public body of the Department of Health. Its formation came as a result of reorganisation of the National Health Service (NHS) in England outlined in the Health and Soci ...
were to be merged, although there would not be a complete merger of the organisations. In April 2016 both organisations became part of
NHS Improvement
NHS Improvement (NHSI) was a non-departmental body in England, responsible for overseeing the National Health Service's foundation trusts and NHS trusts, as well as independent providers that provide NHS-funded care. It supported providers t ...
which subsequently operationally merged with NHS England from September 2018 and was formally abolished by the
Health and Care Act 2022
The Health and Care Act is an Act of Parliament (UK), Act of the Parliament of the United Kingdom, which is intended to dismantle many of the structures established by the Health and Social Care Act 2012. Many of the proposals were drafted under ...
.
Criticism
In July 2014, Monitor was criticised by the
Public Accounts Committee of the House of Commons (PAC) for the lack of clinical expertise and frontline NHS experience amongst its staff. The PAC noted that: “Only 21 of Monitor's 337 staff have an NHS operational background and only 7 have a clinical background, which damages Monitor's credibility in dealing with trusts and its effectiveness in diagnosing problems and developing solutions”. The PAC also criticised the proportion of Monitor’s budget spent on external consultants (£9 million of Monitor's £48 million budget in 2013-14) and found that “some NHS foundation trusts had been allowed to struggle for far too long in breach of their regulatory conditions. It has taken Monitor too long to help trusts in difficulty to improve, with three trusts having been in breach of their regulatory conditions since 2009”. At the time of the PAC’s hearing, of 147 foundation trusts 39(26%) were expected to be in deficit by the end of 2013-14 and on 31 December 2013 25 (17%) were in breach of the conditions attached to their status.
The PAC also noted: “It is wholly inappropriate that the same person acted as both Chair and Chief Executive of Monitor between March 2011 and January 2014. This was contrary to corporate governance good practice and Monitor's own guidance to NHS foundation trusts”. The board of MONITOR has a majority representation from former or seconded employees of KPMG, PWC and Deloitte while still awarding contracts to these organisations worth millions of pounds.
Regulatory action
In July 2013 six
NHS foundation trust
A foundation trust is a semi-autonomous organisational unit within the National Health Service in England. They have a degree of independence from the Department of Health and Social Care (and, until the abolition of SHAs in 2013, their local s ...
s wer
placed in special measuresas a result of the
Keogh Review
The Keogh Review into patient safety was carried out by Professor Sir Bruce Keogh in July 2013.
This review was ordered by the Prime Minister in response to the Francis Inquiry into poor care at Mid Staffordshire Hospitals NHS Foundation Trust.
1 ...
of patient safety:
*
*
Burton Hospitals NHS Foundation Trust
*
Medway NHS Foundation Trust
Medway NHS Trust is an NHS foundation trust based in Kent which runs Medway Maritime Hospital.
History
The trust was established as Medway NHS Trust on 1 November 1993, and became operational on 1 April 1994.
A proposed merger with Dartford ...
*
*
Sherwood Forest Hospitals NHS Foundation Trust
Sherwood Forest Hospitals NHS Foundation Trust was formed in 2001 and gained Foundation Trust status in 2007. It runs three hospitals in Nottinghamshire - King's Mill Hospital, Newark Hospital and Mansfield Community Hospital. It also operates ...
*
Tameside Hospital NHS Foundation Trust
Subsequent trusts placed in special measures:
*
The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust October 2013
*
East Kent Hospitals University NHS Foundation Trust
East Kent Hospitals University NHS Foundation Trust is one of the largest hospital trusts in England. It runs the Kent and Canterbury Hospital (Canterbury), William Harvey Hospital (Ashford), Queen Elizabeth The Queen Mother Hospital (Margate), ...
August 2014
Enforcement action has been taken on 21 occasions in the first 10 months of 2013/4, compared to just nine instances in the whole of 2012-13. Monitor's former 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 and that increased monitoring and intervention was explained by “a declined appetite for risk” among “Parliament, the government and the public”.
Details of the regulatory action Monitor has taken at NHS foundation trusts are available on its website: http://www.monitor.gov.uk/about-your-local-nhs-foundation-trust/regulatory-action/nhs-foundation-trusts-special-measures-or-un.
In August 2015 Monitor issued a letter to all Foundation Trusts telling them to fill vacancies “only where essential” and warning that current financial plans are “quite simply unaffordable” as NHS providers collectively forecast a deficit of £2bn in 2015-16.
Stafford Hospital investigation
In 2010 the
Stafford Hospital scandal investigation recommended that Monitor de-authorise the
Mid Staffordshire NHS Foundation Trust
The Mid Staffordshire NHS Foundation Trust was a NHS foundation trust which managed two hospitals in Staffordshire, England:
* Stafford Hospital - acute hospital with approximately 350 inpatient beds, opened in 1983, Now renamed County Hospita ...
.
In line with the investigation report recommendation,
Secretary of State for Health
The secretary of state for health and social care, also referred to as the health secretary, is a secretary of state in the Government of the United Kingdom, responsible for the work of the Department of Health and Social Care. The incumbent ...
,
Andy Burnham
Andrew Murray Burnham (born 7 January 1970) is a British politician who has served as Mayor of Greater Manchester since 2017. He served in Gordon Brown's Cabinet as Chief Secretary to the Treasury from 2007 to 2008, Culture Secretary from 2008 ...
, agreed to a further Independent Inquiry of the commissioning, supervisory and regulatory bodies for Foundation Trusts.
Anti-competitive behaviour
Spire Healthcare
Spire Healthcare Group plc is the second-largest provider of private healthcare in the United Kingdom. It is listed on the London Stock Exchange and is a constituent of the FTSE 250 Index.
History
Spire Healthcare was formed from the sale of Bu ...
alleged in 2013 that a block contract agreed between
Blackpool Teaching Hospitals NHS Foundation Trust
Blackpool Teaching Hospitals NHS Foundation Trust is an NHS Foundation Trust providing health services in North Lancashire, England. It runs Blackpool Victoria Hospital which is a large busy acute hospital; two smaller community hospitals - Cli ...
and the
clinical commissioning group
Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integra ...
s in Blackpool, and Fylde and Wyre offered a “clear incentive” for GPs to refer patients to the foundation trust and that this was anti-competitive behaviour. The contract provided the trust with a guaranteed income regardless of the number of patients that chose to use its services. Monitor conducted an investigation and decided In September 2014 that there was no evidence to support the claim though they did conclude that Blackpool CCG’s plans did not “go far enough” to ensure patients would be offered choice, or that the right to choice would be “publicised and promoted”. Blackpool CCG complained that not a single GP, practice manager or patient was spoken to by the investigating team, nor was a single practice visited.
In September 2014 former chief executive David Bennett admitted that the organisation had yet to identify a strategy to counter those opposed to competition because it clashed with their personal ideologies. He claimed organisations were using competition regulations as an “easy excuse” for avoiding making necessary changes.
In October 2014 after the publication of
NHS England
NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...
's ‘Five year forward view’ Bennett defended Choice and competition as "one of the ways in which we can drive change and improvement for patients, and we don’t see that that will cease to be the case” - though competition was not mentioned by NHS England. He also said that Monitor, the
NHS Trust Development Authority
The NHS Trust Development Authority (NHSTDA) was an executive non-departmental public body of the Department of Health. Its formation came as a result of reorganisation of the National Health Service (NHS) in England outlined in the Health and Soci ...
and NHS England planned to develop “a whole system, geographically based intervention regime” which could, include a ‘special measures’ approach to areas facing serious problems with care.
References
External links
*
Response to the Francis report into Mid Staffordshire NHS Foundation Trust 24 February 2010
{{Authority control
National Health Service (England)
Department of Health and Social Care
Defunct non-departmental public bodies of the United Kingdom government
Government agencies established in 2004
2004 establishments in England