The outgoing chief executive of the foundation trust regulator has called for a suspension of the FT pipeline.

  • David Bennett: “I would suspend the current pipeline”
  • Outgoing Monitor chief says foundation pipeline is distracting trust leaders when “we need their attention focused on other things”
  • Calls for shifting of local accountability from providers to commissioners

David Bennett also said there should be a radical reform of the FT policy to transfer local accountability from providers to commissioners.

Speaking days after his departure from Monitor, Mr Bennett told HSJ that the policy of intervening in FTs only “when things go seriously wrong” had been conceived for “a period when money was plentiful” and now needed to be reformed to reflect current austerity.

He revealed that his preferred reform would remove the need for FTs to have a membership within local communities, and put all providers on a “sliding scale” of autonomy linked to how highly they were rated by regulators.

He conceded that the process of Monitor assessment for aspirant FTs was a “significant focus for the leadership of an organisation”, at a time when “we need their attention focused on other things”.

Therefore, he said: “I would suspend the current pipeline; I’d say we’re going to work out a different policy… and in the meantime you’ve just got to focus on doing things better, but with the priorities set by your particular needs, rather than the more general needs of Monitor’s assessment process.”

He said there were two aspects to the way he thought FT policy should be reformed, the first of which Monitor “were doing anyway” and the second of which needed legislation.

The first was to replace the policy of leaving FTs alone unless they were in serious difficulty with a “more nuanced approach”.

He said: “One could easily adopt, and possibly slightly adapt, the [Care Quality Commission] regime.

“Say there are four categories of performance, from outstanding through to inadequate and special measures, and you can say against those four categories of performance you get four degrees of autonomy. That’s essentially what we’re doing today, but I think it would make a lot of sense to formalise it.”

He added: “What this enables you to do in principle is to recognise that freedoms can be taken away as well as granted… I think it’d be helpful to just be very explicit about this.”

Where he thought legislative change was needed was to remove the need for FTs to maintain a local membership and local accountability to populations.

He explained: “Up until the [Health Act 2012] there was an option of de-authorising an FT, but one of the problems with that is it has to give up its membership and its governors and all that.”

If the provider improved and was able to be authorised as an FT again, it would have to recreate these structures.

Mr Bennett continued: “This is where you’d need legislative change, but I think that’s an issue that should be fixed. I think the way I would do it – and this is radical and would be controversial – [is] I think I would get rid of the idea of FTs having a membership. I think FTs and trusts should be treated in the same way.

“Fundamentally this would take away the distinction. You’d have a sliding scale of autonomy. The boards would always be accountable to… NHS Improvement, but with varying degrees of freedom depending on how well they’re doing.

“I would shift the local accountability from an accountability of providers to their local communities, to having commissioners accountable to their local communities… I actually think [this] puts local accountability where it belongs. It’s commissioners who are there to represent the interests and meet the needs of local communities.”

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