National officials are keeping confidential until after the general election potentially controversial information showing which NHS trusts are unlikely to have a future as independent organisations.

  • Information on which trusts unlikely to have independent future to stay secret until summer
  • TDA’s categories show which likely to win foundation status, or to be acquired or franchised
  • TDA says work has not been finalised

The NHS Trust Development Authority has confirmed to HSJ it will not publish a list of the categories it has given to the 90 organisations it oversees until the summer.

These indicate which of the trusts – many of which are struggling to provide good care and balance their books – are expected to have to be acquired by another provider or managed via a management contract or franchise. For those which are expected to be able to achieve foundation status, it indicates how quickly this is predicted to be achieved.

A first draft of the information was completed in November and there was an expectation among many in the sector it would be made public earlier this year.

The TDA told HSJ yesterday that the work was ongoing. However, many trusts have been informed of their own categories in recent weeks and months, and HSJ is aware of the categories of around 10 organisations.

Trusts have been placed in “six broad groups” according to their “likely trajectory towards a sustainable organisational form” (see box, below).

The TDA’s categories for trusts

Organisations with a “clear and credible plan” for becoming FTs in less than two years have been placed in category A1 and those predicted to achieve the status in less than four in A2.

Trusts with the potential to reach foundation status but that lack “a clear and credible plan and timeline for doing so” are categorised as A3.

The segmentation also includes categories for trusts that cannot become FTs in their current form.

Category B1 is for trusts where acquisition by another organisation is likely to be the “best route to sustainability”.

B2 is for trusts where a “franchise, management contract of other innovative organisational form” is the recommended option.

Category C is for organisations where further work is needed to determine their future.

The TDA said in September its categorisation would “bring clearer strategic direction to our work with individual organisations”, allowing it to “target its efforts more specifically to the issues facing particular groups of trusts”.

An initial list was completed in November and a board paper posted on the TDA’s website last month said categories had been “communicated with organisations”.

The paper was subsequently taken down from the website and replaced with a revised version where this reference had been removed.

The TDA said it would not publish the results until the summer because the current planning round, which has been delayed by the 2015-16 tariff row, is likely to affect trusts’ future strategies.

It said this meant the list would need to be “refreshed” once this was complete.

A TDA spokeswoman said it was “currently working with trusts to ensure that they have a sustainable organisational form so that they can provide high quality care for patients”.

“This work cannot be finalised until trusts and clinical commissioning groups have completed planning discussions for 2015-16,” she added.

The information is likely to be sensitive because it indicates how many and which NHS organisations are unlikely to have a future. Although it does not mean their services will close, this is often unpopular with supporters of the organisations, and in some cases does indicate major changes to services are required.

Last year Sir David Dalton, the chief executive of Salford Royal Foundation Trust, led a government review on NHS provider organisational forms, which recommended the TDA should publish the list “at the earliest opportunity”.

In an interview with HSJ after his review was published he speculated that 20 to 30 trusts might need to be taken over or run as a franchise.

Speaking to HSJ yesterday about the TDA’s approach, Sir David said: “It’s now over 10 years since FTs first appeared.

“The standards to be achieved are reasonable both in terms of financial and clinical viability, and so the organisations that haven’t been able to provide a convincing case after 10 years, I think it’s quite reasonable for the NHS and the public to be asking whether they’ll ever be able to reach the standards that are necessary.”

He added: “What’s really important is that we don’t seek to preserve the organisations in their current form if those organisations aren’t able to deliver high standards of care reliably and economically.”

Miriam Deakin, head of policy at NHS Providers, said the TDA’s categorisation work was a “helpful move… and we look forward to hearing more detail on how all trusts will be supported to achieve sustainable forms”.

However, she added that “considerable uncertainty remains over the future of a number of NHS trusts within the categorisation”.

Updated: HSJ has decided not to publish the categories of the ten trusts which we are aware of at present, as it would provide an incomplete picture. Readers wishing to get in touch in confidence in relation to this story can email will.hazell@emap.com

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