Struggling foundation trusts may be forced to take on new Monitor troubleshooters who will advise trust boards and inform the regulator about weak board members, HSJ has discovered.

A report to Monitor’s January board said it was exploring the options for retaining a stable of “chief restructuring officers”, available to install at FTs in breach of their terms of authorisation.

These experts would advise chief executives on how to return their trusts to compliance, but also report back to the regulator on “whether board members needed to be replaced”, it states.

The approach marks a departure from Monitor’s current tactic of replacing chairmen or executives at FTs with the most severe problems. The report warns Monitor may face a shortage of interim replacements in the future, and that replacing board members “has the potential to destabilise an already challenged trust”.

But Foundation Trust Network chief executive Sue Slipman told HSJ: “I don’t think you can act as the ears of Monitor inside the board, and constantly report on the board, and be seen as a supportive person helping the board to reach a solution.”

She suggested FTs might feel that Monitor was building “an empire, which has sway over the board directly and internally”. Boards would feel “under surveillance” and the chief restructuring officers would struggle to establish trust.

She added that she was “not sure non-executive directors would be prepared to work like that”.

“At what point do you effectively say the regulator is taking over running the organisation?” she asked. “Is it an independent autonomous board or not?”

The report acknowledges that the tactic could give “the perception of Monitor running an NHS FT, thereby taking responsibility away from the board”. It would need to be clear that the chief executive was “still the accountable officer, but acts on advice given by the CRO”, it states. “In particular, the CE should regard the CRO as a supportive adviser rather than a threat”.

Monitor has only ever installed two interim chief executives – at Mid Staffordshire and the Royal National Hospital for Rheumatic Diseases – and seven chairs.

Its review says the regulator has sometimes declined to remove executives from boards where there were already significant numbers of new members, because it did not want to further destabilise the trust. Monitor has also held back where it did not have “enough proof that the failings of the trust result directly from one or more of the board members’ failings”, it notes.

Some chairs and chief executives on Monitor’s list of potential interims have recently “highlighted a concern about being away from their home trust for more than a short period”, it adds. “There is therefore a risk that we may not be able to identify suitable candidates if required in the future.”

The paper suggests installing a CRO at a troubled trust would avoid risking “the destabilising effect of a change in personnel”, and the “difficulties interims face in driving lasting change”. It would also provide Monitor with “additional visibility on progress at the NHS FT”.

It states that the regulator would adopt the option as part of its approach to managing significant breaches, but would further research “the commercial terms under which we could retain a CRO”. The possibilities it was considering included paying candidates a retainer to ensure they were available when needed, or employing part-time CROs who could carry out other work for Monitor when they were not installed at trusts.

Monitor will also formally adopt the option of a “diagnostic phase” in its intervention process. This involves recruiting a team of specialist advisors after a trust has been found in significant breach to conduct a short investigation of the issues at the FT and recommend possible remedies.

A Monitor spokesman said the paper was to inform its board of “the range of intervention options” existing, highlighting “early diagnostic tools and chief restructuring officers, which although used on occasion in the past, may be required more in future”. 

“Each potential intervention is considered on the basis of the trust’s specific issues and which option will best assist the trust to return to compliance with its terms of authorisation,” he added.