Exclusive: New Monitor strategy to ‘turbo charge’ change

David Bennett told HSJ that mounting financial pressures on the health service had created a “pressing need” to accelerate major reforms to the way care was delivered, and that Monitor needed to play a significant role in “turbo-charging change”.

The regulator would in future place less emphasis on the long term financial projections of foundation trusts or trusts applying for foundation status, and more on the capabilities of those organisations and their leaders, he said.

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Monitor would also have to be flexible in allowing FTs and aspirant FTs to move to new business models, he added.

Mr Bennett told HSJ: “We are not going to get change happening if Monitor is rigid in the way it looks at business models and says, ‘Where’s your five year track record? Where’s your five year plan?’ No organisations in the [FT] pipeline will be able to change if we require that.”

The drive to shift less-complex acute care out of hospital settings and more-specialist work on to fewer, larger sites had left those running district general hospitals “caught in a pincer movement”, he continued. If they were going to survive, they would have to “reinvent what a district general hospital does”.

“That’s the sort of change I’m talking about,” he said. “We need organisations, we need [leaders] of those organisations, that are capable of dealing with that sort of change.”

The real test of whether an applicant or existing FT was “up to the job” would be their capability to “make change happen in their organisations” and to “deal with the change going on around them”, said Mr Bennett.

Monitor’s new strategy, published this week, said to assess this it would focus more on organisations’ strengths in areas that “drive long term performance”, including individual leadership, strategic planning and operational performance improvement.

However, Mr Bennett added that this was not about “raising the bar” for would-be FTs, and in exchange for its closer attention to these capabilities, Monitor would reduce its emphasis on “the numbers” in trusts’ long term financial models.

“The notion that you get very hung up about any numbers beyond year three [of a financial plan] I think is getting a bit out of date,” he said.

“For an applicant trust’s ongoing business, it’s changing so much, the uncertainties get so great when you get much further out.”

Monitor has already begun talking to the NHS Trust Development Authority – which is responsible for shepherding the remaining NHS trusts to FT status – about the implications of its planned shift in emphasis.

Monitor’s new strategy also promised to “lower barriers to change” by accepting that “foundation trusts must be able to take measured risks as they shift to new business models”. Not to do so, it explained, could lead to “much greater long run risks for the sector as a whole”. The regulator added that this in turn meant “we must all accept” that some providers may fail.

Asked why this increased flexibility was necessary, Mr Bennett gave the example of an NHS trust board member who told him that their trust could not pursue its aspiration to become an integrated care organisation because it had to become an FT. He explained that he wanted to send a “very clear signal” that “any thinking of that sort” was wrong.

The strategy also says Monitor will work with NHS England to help local commissioners develop “health economy strategies” that could assist providers with “underlying structural problems” to avoid Monitor’s failure regime.

Mr Bennett said placing FTs in the failure regime - as Monitor did with Mid Staffordshire Foundation Trust - was the “last resort”, as it was “expensive”, “disruptive” and “not something we should happily do”.