News / Administrator to be appointed to failing foundation trusts

Foundation trusts that are no longer financially sustainable would not revert to health secretary control under a proposed failure regime. Instead they would come under the control of an administrator charged with ensuring continuity of service.

Amendments to the health and social care bill, published by the Department of Health in response to the NHS Future Forum’s report, set out a new continuity of services regime that builds on the existing arrangements.

A failing foundation would no longer be de-authorised and revert to ministerial control. Instead, in the first instance Monitor would intervene to prevent foundation trusts becoming unsustainable. As a last resort the regulator could trigger the continuity of services regime and appoint an administrator to take control of the provider’s affairs.

Having regard to current and future need and equality of access, commissioners would be required to identify where the withdrawal of services would have a big adverse impact on health, increase health inequalities or cause a failure to prevent or ameliorate damage to health. Commissioners would also be required to identify where there were no alternative providers.

The administrator and commissioners would agree a report on how continuity of services could be secured. There would then be a 30-day consultation with patients, the public, staff, Health and Wellbeing Boards and local Healthwatch organisations. Having agreed any changes following consultation, the commissioner would submit a report to Monitor, which would prepare a final report for the health secretary.

This report would be written having also taken into account the clinical case for any proposed change and the views of the Independent Reconfiguration Panel and Care Quality Commission (CQC). The CQC would identify any concerns over quality and safety of the provider’s services. In exceptional circumstances, the health secretary would have a power of veto over the proposals.

There was some concern over the planned veto for the health secretary. ‘The proposed failure regime, while not as independent as we had hoped, in principle looks workable, although we will only know for sure when detailed regulations are available,’ said Sue Slipman, chief executive of the Foundation Trust Network.

She added that foundations would be worried they could be forced into failure as a result of the current economic climate.

‘We welcome the time limits that kick in to ensure service continuity for patients in the event of failure,’ she said. ‘But given the ongoing financial challenges in the NHS, the key issue is that providers need to be able to reconfigure services in order to avoid distress and failure in the first place.

‘Unless the NHS can facilitate such changes, organisations could be pushed into failing because the blockages to change at an earlier stage can turn challenge into unnecessary failure.’

Monitor welcomed the plans. ‘The failure regime allows clinical and financial problems to be addressed at a local level  to ensure service continuity and high-quality care in the long term,’ a spokesman said. ‘Commissioners will have the primary responsibility, but Monitor will have an important role in ensuring this is delivered.’

The regulator said measures would be put in place to protect patients receiving services from independent sector providers.