07.07.14
Lack of clinical expertise hampering Monitor’s effectiveness – PAC
A lack of clinical expertise and frontline NHS experience is hampering the effectiveness of healthcare watchdog Monitor, a new Public Accounts Committee (PAC) has claimed.
The review – Monitor: regulating NHS Foundation Trusts – highlighted that only 21 of Monitor’s 337 staff have an NHS operational background and only seven have a clinical background, which PAC claims damages Monitor’s credibility in dealing with trusts and its effectiveness in diagnosing problems and developing solutions.
The committee of MPs also stated that the watchdog’s ‘extensive’ use of external consultants to fill gaps in its ‘capacity’ and ‘expertise’ restricts its ability to build in-house expertise and knowledge. Additionally, the use of consultants has been costly, accounting for some £9m of Monitor’s £48m budget in 2013–14.
PAC has called on Monitor, which regulates 147 foundation trusts, to make better use of its resources to drive improvement and make sure the trusts balance their books.
The committee stated that at the time of its hearing Monitor estimated that around a quarter (39 of 147) of foundation trusts would be in deficit by the end of 2013–14. And, as of 31 December 2013, 25 trusts (one in six) were in breach of the conditions set when they were awarded foundation trust status.
PAC has stated that Monitor should now explain how it prioritises the protection of patients’ interests above those of NHS foundation trusts, and demonstrate how it does so in practice, to allay concerns that its new responsibilities are conflicting.
Margaret Hodge MP, chair of the PAC, said: “These trusts are suffering from serious financial pressures, poor leadership or both, and some have been allowed to go on struggling for more than four years.
“Monitor has got to get much better at identifying and taking radical action in trusts at risk of failure. However, its effectiveness is undermined by a lack of frontline NHS experience.”
The MPs also believe there is potential for overlap between all the bodies responsible for regulating the NHS, including Monitor, as well as for gaps in oversight.
In response to the report, David Bennett, chief executive of Monitor, said: “This criticism comes in the wake of a report from the National Audit Office which said Monitor provided value for money in regulating NHS foundation trusts and was generally effective in helping them to improve.
“However, the committee does put its finger on some of the difficult issues the NHS faces as rising public demand and expectations of healthcare put pressure on the budget. As the regulator, Monitor is not responsible for the tough financial circumstances in which trusts find themselves.
“Although the NHS foundation trust sector as a whole is currently in surplus, a minority of trusts do face complex operational and leadership challenges, including issues about the quality of care patients receive. We are working hard with our NHS partners to support trusts in solving all these problems. We acknowledge there is always room for improvement, and we are already taking action along many of the lines recommended by the committee.”
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