08.10.14
Monitor licences 'leading to reduced hospital community services'
Licence conditions imposed by Monitor on NHS foundation trusts (FTs) in England will force cutbacks of hospital community services, two experts have warned.
Writing in the BMJ, professor of public health research and policy Allyson Pollock, and Peter Roderick, barrister and senior research fellow, both of Queen Mary University of London, claim that this is all being done “under the guise of continuity”, but question its legality.
NHS FTs were introduced in 2003 under conditions set out in ‘authorisations’ from Monitor, they explain. And these designated certain services as mandatory. But the 2012 Health and Social Care Act replaced authorisations with licences issued by Monitor to ensure “the continued provision of healthcare services”. As a result, they claim, services listed as mandatory before the Act came into effect were re-designated in the new FT licences as ‘commissioner requested’ services.
These services have to be provided up to April 2016, they add. But, between now and then, commissioners have been told by Monitor to identify services that would need maintaining if an FT was unable to pay its debts.
“The effect will be to reduce NHS-funded care to a basic package of services equivalent to those that must be provided in the event of foundation trust failure,” warn the authors.
Furthermore, they say many decisions about what are essential services will in effect be made by management consultants. Commissioners do have a legal duty to arrange services to meet reasonable requirements, say the authors, but under Monitor’s conditions of service guidance they are being asked to consider the “minimum services” required under the assumption that a trust will become bankrupt.
“If consistently applied, the logic of Monitor’s approach for determining commissioner requested services is that FTs will provide a smaller core set of services by April 2016, even though they are not failing or at risk of failing,” they write. They also question the lawfulness of applying this approach across all 147 FTs, regardless of their individually assessed risk of failure.
They describe Monitor as an “octopus” with its tentacles extending with government approval to “overruling commissioners, to planning for failure, to reducing NHS-funded care to a basic package of services, and to discontinuing services under the guise of continuity”.
NHE has sought comment from Monitor and the Foundation Trust Network on this analysis, but at the time of publication had received no reply.
It has also been confirmed that the regulator is changing the process for collecting financial information on FTs. The trusts have now been asked to provide monthly financial information, starting from August’s data.
Previously, only FTs with financial problems had to provide monthly updates.
But in a letter to FT finance directors, Jason Dorsett, Monitor’s director of finance, reporting and risk, wrote: “We have agreed with the DH to require a regular monthly report from every NHS FT of its forecast year end outturn position in respect of: 1) surplus/deficit (before impairments and gains or losses from transfer by absorption); and 2) capital expenditure (on an accruals basis).”
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