If an NHS foundation trust has failed to comply with the terms of its authorisation and this is significant – for example, if it consistently fails to meet required standards of care or is at financial risk – Monitor's Board may decide to use its statutory powers of intervention. Where we do intervene formally, it is always with the aim of resolving issues as quickly as possible and in the most effective way.
Our intervention powers are broad and range from closing a specific service, if we have serious concerns about it, or requiring a board to take – or not take – a specific action(s), requiring a board to obtain external advice on a particular issue, or, in extreme cases, removing any or all of the directors or governors and appointing replacements.
Monitor’s formal powers of intervention are described under Section 52 of the National Health Service Act 2006. To date Monitor has used its formal intervention powers in the following NHS foundation trusts.
In March 2010 Monitor found the trust to be in significant breach of its terms of authorisation due to the trust’s failure to comply with its duty of governance in relation to organisational and clinical leadership capacity within the trust’s maternity service.
Monitor used its regulatory powers to require the foundation trust to appoint external expert clinical advisers to assist the foundation trust to accelerate the delivery of necessary improvements within its maternity service.
In November 2009 Monitor found the trust to be in significant breach of its terms of authorisation due to the trust’s failure to comply with healthcare standards; its failure to exercise its functions effectively, efficiently and economically; and serious and wide ranging concerns as to overall governance and leadership at the trust.
Monitor used its regulatory powers to remove Mr Richard Bourne as Chair of the trust with immediate effect and appoint Sir Peter Dixon as interim Chair of Colchester Hospital University NHS Foundation Trust with effect from Monday 30 November 2009.
In November 2009 Monitor found the trust to be in significant breach of its terms of authorisation due to concerns around leadership and quality of care at the trust.
Through the use of its formal powers of intervention, the actions Monitor is requiring the trust Board to take are to:
- use an expert taskforce to manage and report on the delivery of plans to improve quality of service;
- agree with Monitor the objective performance metrics against which the trust’s performance will be measured and reviewed monthly; and
- take immediate steps to strengthen senior clinical capacity, in particular, to provide additional support to the Medical Director and Director of Nursing.
In October 2009, Monitor found the trust to be in significant breach of its terms of authorisation due to a failure to comply with its general duty to exercise its functions effectively, efficiently and economically.
On 29 October 2009, Monitor used its formal powers of intervention to appoint - with immediate effect - an Interim Chair at the trust. Jeffrey Ellwood has been appointed as Interim Chair following the decision of the trust’s chair, Robin SeQueira, to resign. In addition, Monitor required the trust’s Members Council to immediately commence its formal recruitment process to appoint a permanent chair.
In July 2009, Monitor found the trust to be in significant breach of its terms of authorisation as a result of a rapid decline in its financial and operational performance.
The trust was required to submit a recovery plan, which was presented to Monitor in October. Monitor’s Board did not consider that this plan was robust enough to ensure the trust’s return to a sustainable position, or that it demonstrated that the trust had in place the board and clinical leadership necessary to achieve this.
On 13 October 2009, Monitor used its formal powers to intervene at the trust to ensure it has the board-level leadership and capacity needed to return to a secure position, while at the same time ensuring patient care remains the highest priority. Chris Langley has been appointed as Interim Chair following the decision of the trust’s Chair, Dr Tim Lincoln, to resign. Monitor's Board has also required the trust to appoint an interim medical director, in the absence of a current substantive appointee to that executive position on the trust’s Board.
View the intervention notices on the NHS foundation trust directory.
On 15 July 2009, Monitor used its formal powers to appoint Antony Sumara as Chief Executive of Mid Staffordshire NHS Foundation Trust. Mr Sumara took up post on 1 August.
In appointing Mr Sumara, Monitor’s Board took action to ensure the trust has full time leadership in place to take it through the next phase of its recovery. The new Chief Executive, along with Sir Stephen Moss, the Chair appointed by the trust, will build on the good progress made by the Interim Chair, David Stone, and Interim Chief Executive, Eric Morton, to successfully deliver the trust’s Transformation Plan.
Monitor previously used its formal powers of intervention at Mid Staffordshire NHS Foundation Trust in March to appoint an Interim Chair, and direct the appointment of an Interim Chief Executive in March 2009.
Monitor continues to hold Mid Staffordshire NHS Foundation Trust to account at each step towards delivery of its Transformation Plan, which addresses the recommendations made by Professor George Alberti, Dr David Colin-Thomé and the Healthcare Commission.
If the trust fails to deliver the planned actions to address the issues identified within agreed timescales, Monitor will take whatever further regulatory action is necessary to deliver improved patient care.
View the intervention notices on the NHS foundation trust directory.
In April 2008 the trust’s recently appointed Director of Finance (and the trust’s advisors) identified a significant control weakness in the trust’s accounts. This resulted in a financial risk rating of 2 in quarter 4 of 2007-08 (a reduction from a rating of 3 in other quarters of 2007-08 and 1 for its annual plan 2008-09).
On 4 August 2008 Monitor used its formal powers to intervene under Section 52 of the Act. The particular aim was to ensure that appropriate regulatory control was in place to assist in the maintenance and protection of trust services for patients.
Since August 2008, the trust has completed the three actions specified in the original intervention notice:
facilitating a review by Monitor of the trust’s working capital position and forward cash flow over the period of the next 12-18 months;
appointing PricewaterhouseCoopers to review the financial control and commercial management at the trust; and
making appropriate arrangements to satisfactorily resolve the position of the then chief executive.
It also prepared a plan for financial recovery which it presented to Monitor at the end of November. In December 2008, Monitor’s Board decided to intervene for a second time, in order to secure the resources and skills required to deliver the trust Board’s strategy and longer term financial stability.
In April 2009, Monitor's Board intervened for a third time to appoint an Interim CEO and Interim Chair.
View the intervention notices on the NHS foundation trust directory.
In the case of Bradford Teaching Hospitals NHS Foundation Trust, Monitor used its statutory powers of intervention twice in 2004. The first was to require the appointment of external advisers, and shortly after, the appointment of a new chair. These were the first occasions on which Monitor used its powers. View the intervention notices on the NHS foundation trust directory.
This action was taken after monitoring of the trust indicated that actual financial performance was significantly behind that forecast at authorisation.
The steady improvement in its financial performance meant the trust returned to quarterly monitoring in 2006 , in line with the majority of NHS foundation trusts.