Monitor is encouraging trusts to use service line management to improve quality and control costs, amid evidence that senior management is taking back control of trust finances.

Service line management involves identifying costs associated with a particular type of treatment – often at patient level. One of its goals is to allow clinical directorates to manage their own budget. The regulator’s new guidance on helping trusts implement the system was due out as HSJ went to press.

Monitor policy adviser on trust development Kate Hall said some foundation trusts had not implemented service line management at all, while some non-foundations were more advanced.

The Healthcare Financial Management Association last week held a conference on the potential and practicalities of ceding control and responsibility to clinicians through service line management.

King’s Fund senior fellow Catherine Foot, who is running a research project on service line management and spoke at the conference, said the preliminary findings indicated “huge variation” in its implementation.

She added that the research team had found “control being taken back into the centre [returned to trust management] over the past two to three years” and that the unique circumstances of each trust had meant there was no off-the-shelf solution to introducing it.

A Department of Health survey last year found only around half of trusts were using a patient level information costing system, a form of service line management.

More recent statements from the DH’s payment by results team have supported more organisations using the patient costing system.

Chelsea and Westminster Hospital Foundation Trust finance director Lorraine Bewes said it had helped her organisation achieve its 2010-11 savings plan of 10 per cent.

She told HSJ: “It allows for a very clear picture of exactly what everything costs. And when you share the data with clinicians and allow them to challenge it, you can quite quickly get improvements in procurement, theatre utilisation or whatever it is. Often it’s something they know instinctively anyway.”