STRUCTURE: Monitor has ordered the board of the country’s smallest foundation trust to develop a strategy for its future after concluding it cannot survive on its own.

Bath based Royal National Hospital for Rheumatic Diseases Foundation Trust has a turnover of just £21m and has been struggling with a decline in referrals for its specialist services.

In a statement Monitor announced it would be increasing regulatory scrutiny at the trust, known locally as The Min, after concluding it was not complying with its duty to “exercise its functions effectively, efficiently and economically”.

However, the regulator highlighted there were no concerns about quality of care or governance and warned “actions taken by the trust alone” would not be sufficient to address the financial problems.

Monitor’s chief operating officer, Stephen Hay, said: “In this case, there is no single cause for the problems, but the relatively small size of the trust and limited number of specialist services it provides are important factors.  That is why the trust is focused on delivering a long-term strategy setting out how these services will be provided in the future.”

The local health community has been aware of the trust’s unsustainability for some time and discussions have taken place with Royal United Hospital Bath Trust about a potential merger.

However, Royal United has yet to achieve foundation trust status meaning other options may have to be considered.

The Min’s medical director Dr Ashok Bhalla said: “The Min is known for its services, its culture, the quality of its staff and the care and treatment it provides to the people who use it. Providing high quality care to our patients is what the organisation and its entire staff prides itself in.

“It is the services that are important. Our focus now is how we can preserve these services so that they can continue to be available to people in the future in new and sustainable ways.”