The three NHS regulators have agreed to put together a joint description of good leadership in NHS providers.
The idea is proposed in a joint document published today by Monitor, the NHS Trust Development Authority and the Care Quality Commission, which summarises the work they are doing to ensure their separate assessments of trust leadership fit together.
Under its overhauled inspection model, the CQC assesses whether trusts are well-led. It is now considering looking at providers’ financial performance to help make judgments about the quality of trust leadership.
Monitor and the TDA also assess governance when deciding whether trusts should receive foundation status, so the three bodies have begun work on an “aligned well-led framework” which will trusts will be able to benchmark themselves against.
They said a “well-led” trust would have leadership and governance which delivers high-quality care for patients, supports learning and innovation and promotes an open culture.
The regulators said a joined-up approach would remove unnecessary duplication and burden on providers. It will be introduced in October after being tested with trusts.
The document reveals that the three regulators are aiming to cooperate more closely in relation to trusts’ financial governance. This will include the CQC “exploring ways to incorporate into its part of the well-led assessment a commentary on a trust’s ability to sustain high quality care, based on financial information provided through Monitor and TDA’s existing oversight of financial governance and risk”.
Alex Baylis, CQC head of acute sector policy, told HSJ that if a provider had an unsustainable budget deficit with the potential to impact care quality, it would often be “difficult” to say it was well-led.
As well as considering the overall financial stability of trusts, he said the CQC would look at whether there had been “cutting of corners” on care quality when trusts pursued cost savings.
Mr Baylis said there would however be some cases where a trust was well-led but struggling financially because of reasons beyond their control, such as private finance initiative obligations. In such a case the CQC would make its judgment on the trust’s leadership based on how effectively this PFI debt was being managed by the board.
He added that the CQC would only look at financial performance insofar as it impacted on care quality, and that Monitor and the TDA would continue to be responsible for the day-to-day financial oversight of trusts.
Miranda Carter, executive director of assessment at Monitor, said: “Our approach, as with the NHS TDA, is complementary to the CQC, because we are looking from the board down and they are looking from the ward up, so the partners working together achieve a comprehensive picture of how well-led a particular NHS organisation is in providing front-line care.”