Monitor sets out plan to enlist 'superbuddies'

The purpose of the agreement would be to create a pool of strong trusts that can quickly be brought in when regulators decide they need to put in a support package at a challenged trust, David Bennett told HSJ.

He described these “superbuddying arrangements” as being more long term than the buddying system for trusts in special measures, but significantly short of a formal acquisition or franchise.

He said that Guy’s and St Thomas’ Foundation Trust was currently providing “this sort of super-buddying arrangement” for Medway FT, which amounted to a “broad spectrum, multiyear support package with a significant amount of senior resource from Guy’s and Tommy’s in at the trust”.

He continued: “It’s that sort of idea we want to see if we can build on.

“We’re going to try and put a framework [agreement] in place that means it’s much easier to choose a candidate when we’ve got a serious problem at one of our trusts.”

The framework would be for “very strong trusts to provide broad based multiyear support for failing organisations”.

Mr Bennett accepted that the “big challenge” to the plan would be incentivising strong performers to invest management resources in fixing the problems of organisations in which they have no direct strategic interest.

In Guy’s and St Thomas’ case, he suggested, the main motivation had been “altruism”.

“Will that be enough [for others]?” he asked. “We’re going to have to sound people out before we go to formal procurement exercise, and I think part of that will flush out the degree of willingness to do this without some form of incentive.

“If it’s not enough we’ll have to think about what sort of incentive to put in place.”

He acknowledged that the Monitor plan was similar to the Dalton review proposal of a “credentialing” system, in which accredited organisations would be able more easily to take over or franchise struggling counterparts.

Mr Bennett said that the opportunity for acquisition could be a potential incentive for “superbuddies”, but there was limited appetite for such takeovers among strong trusts.

“It could be acquisition, it could be chains,” he said. “The reason I’m not proposing that is the only option is because in the conversations we have had… many [trusts] were to an extent willing to take the Guy’s and St Thomas’ altruistic point of view they’re all part of the NHS at the end of the day, they should be willing to help, but were not interested in acquisition. 

“So I don’t want to limit ourselves. I’m not ruling it out, and we may be able to construct this so it could finish up [either] with acquisition or just a long-ish term superbuddying arrangement.”