The NHS Trust Development Authority may have a lower profile than the service’s other new organisations, but it will influence the future of non-foundation trusts for years

Of all the new organisations to have been created as a result of the reforms, the NHS Trust Development Authority has had the lowest profile. This is partly because its resources are dwarfed by NHS England and Public Health England, or those of the transformed regulators Monitor and the Care Quality Commission. But this boutique new agency has the potential to make as many waves as any of them.

‘Where the stars align, the authority will work with commissioners to facilitate acquisitions and disposals’

After all, the authority’s job is to steward a group of trusts that include the great majority of those facing serious questions over their existence. Its role is to help determine whether these organisations have a sustainable future and, if not, to play a leading role in constructing an alternative solution. A Daily Mail subeditor would describe them as “the government quango in charge of closing hospitals”.

The authority is very understandably keen to create a different impression, stressing how it wants to take a holistic approach to deciding the best answers for those organisations that have not yet achieved foundation trust status. It would also no doubt remind the Daily Mail that many of its charges are hale and hearty organisations.

This is not just PR, the future for non-FTs has shifted subtly but profoundly over the last six months as a result of a number of factors. The most obvious was the publication of the Francis report and the government’s subsequent further dialling down of the urgency of trusts becoming FTs. The second important factor is the imminent closure of the “reconfiguration window”; the unwritten understanding that any major change in hospital services taking place 18 months before a general election is likely to face stiff political opposition.

In for the long haul

The key third factor is the dwindling of the belief that radical solutions can deliver practical solutions. Circle’s management of Hinchingbrooke Health Care Trust may be joined by one or two similar schemes at the most, while in south London the use of the failure regime has so far produced only politically muddled shuffling of the resource deck.

Throw in a range of complicating factors - including a cohort of inexperienced commissioners; the new interest of the Office of Fair Trading in NHS mergers; and two reviews of hospital safety - and reshaping the provider sector looks more challenging than ever.

But this does not remove the main reason behind the need to reshape England’s hospitals: a steady, sometimes brutal, decline in available funds.

Authority chief executive David Flory made it clear to HSJ trusts will increasingly have to ask themselves, “Is this a service we can still continue to provide with the resource available?”.

‘The authority, or another body with a very similar role, will be part of the NHS for many years’

Where the stars align, the authority will work with commissioners to facilitate acquisitions and disposals. But for the reasons stated above a significant amount of its work will be involved in simply getting a trust from one year to the next. This will involve championing those trusts it believes are going in the right direction − including arguing the case with the Department of Health and commissioners for extra funding − and intervening directly to challenge and perhaps replace the leadership of trusts it does not think are making enough progress. The authority’s clarity of focus will mean its influence on, for example, the efficiency plans of its charges will surpass that of even the most enthusiastic strategic health authorities.

Mr Flory admits the goal of achieving an “all-FT sector” has extended by a couple of years − taking us beyond the next election. He is also keen to stress the new organisation is not planning to operate in a way which unnecessarily prolongs its own life. But the authority, or another body with a very similar role, will be part of the NHS for many years.

Flory: 'Loss of experience is greater than I’ve seen'