• Monitor considering putting up to 25 trusts into turnaround
  • Process would be the largest programme of intervention in the acute sector since the “Keogh reviews” process in 2013
  • HSJ understands a list of the target trusts has not yet been drawn up

Monitor has sounded out management consultancies about a possible move to put up to 25 trusts into turnaround, HSJ can reveal.

The move would see turnaround experts sent into the most troubled organisations to embark on significant programmes of work.

The regulator yesterday confirmed to HSJ that it was considering “a programme of support” for trusts but had not decided how many organisations would be affected.

Monitor circulated documents to some potential providers of the programme in December but so far the work has not moved forward.

If implemented across 25 trusts – or roughly one-sixth of the acute sector – the programme would be one of the biggest single interventions in the day-to-day running of providers since NHS England medical director Sir Bruce Keogh led a review of 14 trusts with persistently high mortality figures in 2013.

Turnaround typically involves a rigorous review of financial controls, cash management systems, contracting and clinical processes.

HSJ understands the list of trusts to be put into turnaround is still being drawn up.

A programme of this size would likely cost tens of millions of pounds in consultancy fees.

It is not clear which trusts would be placed in turnaround if the criteria were purely poor financial and access time performance.

NHS Improvement, an amalgam of Monitor and the NHS Trust Development Authority, had its first board meeting yesterday and considered a report on the performance of the provider sector for which it is responsible in the private part of the meeting.

NHS Providers chief executive Chris Hopson said: “We would welcome a programme focused on genuinely creating long term sustainable solutions to what the NHS knows are a group of providers with serious long term challenges. The group is well known and the service has tried to develop sustainable solutions in the past but failed.

“Three things are needed to ensure any programme works this time: listening to the local providers who usually have the answer but have been unable to implement it without the right support; recognising that any solution must be system wide; and that this is about sustainable structural solutions, not just ‘sack the board and appoint an improvement director’. We also need to be clear about how any programme would relate to the success regime.”

Three regions are currently in “the success regime” - whereby all of the NHS organisations in a patch are supported to improve the performance across the whole area.

The success regime areas, announced last June, are in Cumbria, Essex and Devon and NHS Improvement chief executive Jim Mackey yesterday told his board the pace of change in these places had not been as quick as he would like.

Monitor considering putting 25 trusts into turnaround with management consultancies