The foundation trust model could come under question as the NHS faces up to the “absolutely huge” financial challenge, David Bennett has said.

The chief executive of Monitor said although the “process” of gaining FT status had often brought improvements for trusts, progress had then stalled in many cases.

In a speech to provider finance directors in Birmingham last week, Mr Bennett said:

  • The autonmy of FTs can “get in the way” of redesigning services.
  • There will be increasing pressure from government to provide evidence that “everything is being done” to find efficiency savings.
  • Capitated budgets will need to replace ‘payment by results’ in many areas.

Speaking at the Healthcare Financial Management Association conference, Mr Bennett revealed the latest forecasts show the FT sector finishing this year an “unaffordable” £989m in the red.

On the future of the FT model, he said: “Some of this quite honestly does present some challenges to the FT model. It looks as though the process of becoming an FT has led to a step up in performance, but there’s been no acceleration away from the rest of the pack (after acheiving FT status)…

“The autonomous organisational model can get in the way of designing services, and we’ve got to be open to drawing different boundaries.”

He warned that pressure is set to increase from ministers for the system to show “we can live within our means”.

He said: “I do worry about the pressure that’s constantly there to get more and more information to find out what’s going on, and the challenge that brings for you.

“But we must demonstrate that we are doing that, or people are going to demand more and there will be more interference, frankly, from above.

“One reality we’ve got to accept is there’s a lot of anxiety at very senior levels in government as to whether the NHS can live within the means that it’s got .

“We all have to accept that from the government’s point of view the NHS has been treated relatively generously. Therefore the presumption is there’s not going to be anymore money found.

“The worry for Number 10 and the Treasury is, none the less, we want the NHS to deliver good quality services to a growing population.”

When asked about the ‘payment by results’ tariff system, he said: “There’s a huge problem with it. It’s one simple approach to paying for services which may not be appropriate. I certainly think we need to be moving away from it in many areas and capitated budgets are often the better approach.

“Even where payment by activity remains appropriate, we should think about better ways of doing it.”

While he felt the £22bn efficiency target for the NHS was achievable, through new models of care and learning from other health systems, he said the challenge was achieving this within five years.

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