Bennett: Monitor-TDA merger makes a lot of sense

David Bennett said having “a single national oversight body” for all providers would make it easier to work out how to bring about the new care models advocated in the NHS Five Year Forward View.

Under the Health Act 2012, Monitor retained responsibility for regulating foundation trusts, while the TDA was created to steward the remaining trusts to foundation status.

But, speaking exclusively to HSJ, the Monitor chief executive admitted: “An increasing number of people are talking about the idea of merging what Monitor does and what the TDA does. Of course I can see a lot of sense in that.”

Mr Bennett said he did not think there would be significant cost savings from a merger because the two organisations work hard to ensure that “there is not much duplication”.

But he added: “It would be foolish, wouldn’t it, not to acknowledge that the worst performing FTs would be way down amongst the non-FTs in terms of their performance?

“So we’ve got overlapping spectrums now, and you could [ask]: does that really make sense?”

He suggested that it was worth considering the idea of having a spectrum of trusts, with “those performing most strongly having very high degrees of autonomy” and “those performing least strongly having very limited degrees of autonomy”, without a somewhat “artificial divide” along that continuum.

One way of doing this, he said, would be to do as former health secretary Alan Milburn had suggested and give all NHS trusts foundation status. However, there were also “different ways of doing it”.

He added: “I think there is a lot of merit in having the ‘FT exam’ - our authorisation process. It motivates the non-FTs to sort out their challenges.

“And I think it’s a good indication that a certain minimum - often quite a high minimum - standard of performance has been achieved.

“You’d have to do it in a way where you didn’t lose that.”

The consequence of making such changes to provider regulation could lead people to ask why you should have two separate oversight bodies, Mr Bennett said. “That, I think, would be the main motive [for a merger].”

He added: “If you had a single national oversight body looking at all providers, it would make it easier to work out how to achieve the care models and other changes that are [proposed in the forward view].”