Published: 17/02/2005, Volume II5, No. 5943 Page 6

Foundation trusts could be trapped in an inspectorial 'strait-jacket' if the boundaries between the powers of the Healthcare Commission and Monitor are not made clear, chief executives have warned.

More than 80 per cent of foundation trust chief executives responding to HSJ's survey said there was no clarity between the roles of the commission and the independent regulator Monitor.

Sixty-four per cent said the commission's system would prove too much of a burden alongside Monitor's work.

'I think the territory needs to be resolved between the Healthcare Commission and Monitor; I think there are boundary issues, ' said Andrew Cash, chair of the NHS Confederation's foundation trusts network.

'The danger is that there is overregulation and if you are not caught by one you are caught by another - you are almost wearing a straitjacket; you cannot move.' University Hospital Birmingham foundation trust chief executive Mark Britnell said: 'I think when you take Monitor's requirements with the Healthcare Commission's they are certainly a lot more substantial than what existing NHS trusts have to comply with.

'At a time when all political parties are trying to reduce red tape, it seems ironic that we are now witnessing the greatest regulatory burden in the NHS in recent history.' Mike Cooke, chief executive of South Staffordshire Healthcare trust - which is applying for foundation status - said: 'There is a danger of you being inspected one way and monitored in a different way which can lead to a duplication of effort, you concentrating on the wrong things and maybe the eye being taken off the patient in all of this, which is not what any of us are trying to achieve.' Foundations Trust Network director Sue Slipman said: 'We think the Healthcare Commission should adopt the Monitor matrix on financial risk and governance.

If they do not... we will have dual measurements that will be measuring slightly different things. This will lead to massive public confusion.' But Monitor director of communications Stephen Humphreys insisted there was no overlap and that its risk-assessment was to ensure that foundation trusts complied with their terms of authorisation.

He said the tool was for Monitor and foundation trusts, and was not aimed at the needs of the public and patients.

He added: 'We are working with the Healthcare Commission to ensure that data is shared between the two organisations whenever that is appropriate.'

Who does what?

Healthcare Commission chief executive Anna Walker admitted the activities of Monitor and the commission did overlap and that they needed to be clearer about their roles.

She said Monitor looked at the finance and governance of trusts when providing the licence for foundation status.

'What we have said to Monitor is that we will take their findings on governance and on finance and put them into our ratings system so we have no duplication.' explained Ms Walker.

If foundation trusts were deemed to be failing in finance and governance then Monitor would be expected to take it up.

Ms Walker added: 'When foundation trusts fail in some of the areas we are assessing and Monitor is not then Monitor will take our findings and pursue them with the trust.'