Revealed: DH warnings to pipeline laggards

HSJ can reveal the 19 Department of Health warning letters sent to trusts that have fallen behind schedule in the foundation trust pipeline - one of which includes proposals to use the failure regime for a second time.

The DH’s director of provider delivery Matthew Kershaw told Mid Yorkshire Hospitals Trust in May that it could enter the same failure regime that was last week imposed on South London Healthcare Trust.

In his letter sent on 18 May, Mr Kershaw told Mid Yorkshire chief executive Stephen Eames: “The [unsustainable providers regime] could help to identify a sustainable service strategy.”

In one of a series of examples of the letters presaging the departure of senior figures, Mid Yorkshire announced the mass resignation of all four of its non-executive directors on Tuesday.

The letters warn of “personal consequences” for management teams found wanting. Of the 16 “escalated” trusts - those who have missed key pipeline targets - five have subsequently seen their chief executives depart and another three have seen new chairs and non-executive directors appointed.

The letters also show chief executives admitting to the shortcomings in quality and finance, which meant application targets were missed (see right).

One letter also shows Mid Essex Hospital Services Trust to be considering a merger “preferably” with Basildon and Thurrock University Hospitals Foundation Trust.

In September, all non-foundation trusts had to sign “tripartite formal agreements” with their commissioners, strategic health authorities and the DH setting out the milestones they would hit on their way to gaining FT status.

Trusts are “escalated” if missed targets mean they gain a “red” rating on the DH’s traffic light progress tracker for three consecutive months, or if they miss their agreed date for formally applying to the DH. This is the stage before Monitor makes a final decision on the application.

The letters obtained by HSJ were sent to escalated trusts between January and June this year. Most were written by Mr Kershaw. They reveal that within a month of the tripartite formal agreements being signed three hospital trusts had missed their October application target and been escalated.

A DH document released to HSJ under the Freedom of Information Act in March said the strategic health authorities overseeing the then-escalated North Staffordshire Combined Healthcare Trust and Cambridgeshire community services Trust had “already affected [sic] a change of leadership” and proposed changing the trusts’ FT application dates (news, page 5, 1 March).

The trusts that have been escalated constitute one sixth of the organisations in the foundation pipeline and have a combined turnover of £6.4bn.

Health secretary Andrew Lansley declared all trusts would achieve foundation trusts status by April 2014, but the DH subsequently had to admit that some would not achieve this.

A spokesman for the DH said: ““We still expect the vast majority of NHS Trusts to reach foundation status by April 2014. There are currently 21 NHS trusts with applications to become foundations, either at DH or with Monitor, so already real progress is being made.

“An important stage in helping all trusts become foundations on their own, as part of an existing foundation or in another organisational form was the signing of the TFAs) Each TFA details the issues Trusts face in becoming FTs, and how they should deal with these issues. Although some trusts have not been able to fulfil the plans in their TFA so far, we are taking decisive actions to support these Trusts. Overall there is an unprecedented grip on the FT pipeline.”

Mid Yorkshire and Imperial College Healthcare Trust are now making plans that would see them authorised after this date.

Later this month, the NHS Trust Development Authority will take responsibility for shepherding the remaining trusts through the pipeline. HSJ understands key appointments to the body will soon be announced.