From the policymaker’s perspective, it’s easy to see the appeal of an administration regime for “insolvent” NHS providers.
It is, essentially, an attempt to take the politics out of hospital reconfiguration: to create a mechanism for taking controversial decisions that is legalistic, removed from politicians, and driven by economic realities.
‘Will it be any easier for Hunt to distance himself from the work of trust special administrators when they are appointed by Monitor?’
The problem − as the recent furore over the special administrator’s recommendations in the case of South London Healthcare Trust shows − is that the public remains entirely unconvinced that decisions about changes to hospital services are anything other than political.
Given that NHS providers are operating in a “market” in which most participants have ultimately only one customer − the Treasury − and in which many prices are still set by the Department of Health, there is some justification for public scepticism.
So will it be any easier for health secretary Jeremy Hunt to distance himself from the work of trust special administrators when they are appointed by Monitor, as the regulator will soon have the power to do in the case of foundation trusts?
A public service?
The early indications − following the regulator’s move towards placing Mid Staffordshire Foundation Trust in administration − are that he will not.
‘If Mid Staffs does go into special administration, there are some interesting economic questions the administrators will have to grapple’
The first question Midlands local media were asking HSJ following Monitor’s decision was: “This is a public service − how is it possible to treat it like a high street shop?”
Ultimately, it’s not. As Monitor’s draft guidance on trust special administration shows, the anticipated final stage of the process is a decision by the health secretary.
If Mid Staffordshire does go into special administration, there are some interesting economic questions that the administrators will have to grapple with − notably, whether it is possible to find a configuration of services in that health economy that could meet the needs of Mid Staffordshire’s population without above-tariff subsidy.
But the answers − whatever they are − will be political.