The foundation trust regulator has criticised the “opportunistic” approach of trusts to absorbing community services.
Monitor’s policy director Toby Lambert told an audience at the NHS Confederation conference the Transforming Community Services programme led by the Department of Health had not shown much evidence of being clinically led on the ground.
The process, which was completed in April, saw the provider arms of primary care trusts integrating with mental health trusts, acute services or going independent as community trusts.
“What struck us more than anything else was the sheer opportunistic nature of it,” he said. “’We can squeeze a few percentage points of efficiency from this organisation, let’s do a business plan’.”
He added: “To be fair [the absorbing organisations] were squeezed by a tight deadline from the DH.”
At another Confed session Mr Lambert said: “We risk-rated 20 FTs taking on community services, very few of them are clear on what they are trying to transform themselves into.”
The TCS process saw roughly a third of community services set up independently, a third integrate with mental health trusts and the final third “vertically integrate” with acutes – evenly split between FTs and non-FTs.
Another Monitor director made similar points about TCS at a conference last month.
Head of restructuring and mergers & acquisitions Richard Guest told the Healthcare Finance Management Association in his round-up of the regulator’s year: “We had a number of trusts whose rationale was ‘well, we are a bit small at the moment and we want to grow to survive’. I can’t see the patient benefits of that.
“By and large [TCS applicants] have done their homework and have undertaken thorough legal and financial due diligence. The biggest weak point was clinical due diligence, which some saw as a desktop exercise.
“It has been more of a transfer of community services than a transformation. We can understand the risk management benefits of that but hope other benefits will come through.”