Whole health economies could face intervention for poor performance under a new approach proposed by the NHS national bodies. It could potentially include a ‘special measures’ approach to areas with serious problems.

The NHS Five Year Forward View – published today – said the NHS national oversight organisations would together develop “a whole system, geographically based intervention regime”.

At present NHS England, Monitor and the NHS Trust Development Authority focus their performance and intervention regimes on individual clinical commissioning groups and provider trusts.

HSJ understands that, while legislation requires them to deal with specific organisations – and this will continue, the bodies have decided to focus on whole systems. It may entail a “special measures” style designation for areas with severe problems.

David Bennett

David Bennett said the focus of the report was on ways to drive change besides competition

The approach will build on informal arrangements the three organisations have developed over the past year to work together at national and regional level, in particular in attempts to closely manage hospital waiting times performance.

The forward view said: “Monitor, the TDA and NHS England will work together to create greater alignment between their respective local assessment, reporting and intervention regimes.

“This will include more joint working at regional and local level, alongside local government, to develop a whole system, geographically based intervention regime where appropriate.”

It also reflects the organisations’ joint work this year aimed at addressing the problems of 11 “challenged health economies”.

The forward view also confirms a “special measures” regime will be put in place for CCGs as part of a new “risk based” assurance framework, as revealed by HSJ last week.

The timing for the introduction of the new approaches is not yet known. It is understood the national bodies are grappling with how the approach can work in practice.

A notable absence from the document is any mention of the role of competition. Asked about this at its launch, Monitor chief executive David Bennett said: “Choice and competition are one of the ways in which we can drive change and improvement for patients, and we don’t see that that will cease to be the case.

“But the focus here is on other ways in which we need to drive change.”

HSJ understands that the national leaders do not see competition – a hotly debated subject with public and politicians – as central to the forward view vision.