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 requiring a board to take – or not take – a specific action(s), requiring a board to obtain external advice on a particular issue, to, 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.
The trust was found in significant breach of three terms of its authorisation in October 2011: its general duty to exercise its functions effectively, efficiently and economically; its governance duty; and its healthcare targets and other standards duty.
At the same time, Monitor used its regulatory powers to require the trust to:
The decision to intervene was driven by governance concerns related to the maternity unit at the trust’s Furness Hospital site.
The trust will be subject to enhanced monitoring until Monitor determines that it is no longer in significant breach of its authorisation.
Read the letter sent to the trust’s chair on 11 October 2011, the intervention notice and press release.
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.
View the intervention notice on the NHS foundation trust directory.
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.
Since the trust was found in significant breach and Monitor formally intervened, we have met with the trust regularly to track the progress being made. There has been improvement against all targets and the trust has taken steps to improve planning and governance. A permanent Chair, Sally Irvine, has now been appointed by the Trust’s governors and a new Chief Executive, Gordon Coutts, took up his post in September 2010.
Having demonstrated to Monitor that it had taken action to address our concerns, the trust was removed from significant breach in September 2010.
View the intervention notice on the NHS foundation trust directory.
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.
View the intervention notice on the NHS foundation trust directory.
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.
View the intervention notice on the NHS foundation trust directory.
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 notice on the NHS foundation trust directory.
The trust was found in significant breach of two terms of its authorisation in March 2009: its general duty to exercise its functions effectively, efficiently and economically and the requirement to ensure the existence of appropriate arrangements to provide representative and comprehensive governance, and to maintain the organisational capacity necessary to deliver mandatory goods and services. This was as a result of significant failings relating to quality of care, governance and leadership within the trust.
Monitor intervened in March 2009 and appointed an Interim Chair (David Stone) and required the trust to appoint an Interim Chief Executive (Eric Morton). When Eric Morton’s appointment ended in July 2009, the trust’s recruitment campaign failed to recruit a permanent Chief Executive. Monitor formally intervened again in July 2009 to appoint Antony Sumara as Interim Chief Executive for a period of two years.
At the same time, the trust’s board of governors appointed a substantive Chair, Sir Stephen Moss. The aim of this was to ensure that the strategic and operational leadership was in place to stabilise the trust, enabling it to address the recommendations of a report published by the Healthcare Commission in March 2009, and maintain and build on the momentum of the improvements that had already been achieved.
In March 2011, a substantive Chief Executive, Lyn Hill-Tout, was appointed who formally started in post in June 2011.
The trust was registered by the CQC with conditions in March 2010, all of which have now been lifted. Since registration, the CQC has carried out a number of planned and responsive reviews which have identified both moderate and minor concerns about how the trust is meeting essential standards of quality and safety. More details on these reviews and findings are available on the CQC website. The CQC recognises that progress has been made at the trust in delivering improved care to patients. However, both the CQC and the trust agree that there is still more work to do.
The executive team has been strengthened to accelerate further progress in both quality and finance. The trust recently has made improvements in its A&E department. Major challenges remain to ensure that changes are embedded and sustained, and the trust must improve its quality governance.
Following a strategic review of services delivered at the NHS foundation trust, a long-term plan for a clinically and financially viable solution is being produced. This will help secure the future of the trust. The plan was presented to the trust board in June 2011 and recommendations following from this will form the basis of the NHS foundation trust’s plan going forward.
View the intervention notices on the NHS foundation trust directory.
Monitor intervened on two occasions at the Royal National Hospital for Rheumatic Diseases in 2008-09 due to the trust’s failure to comply with its general duty to exercise its functions effectively, efficiently and economically. Following progress made by the Trust after those two interventions, Monitor intervened for a third time in April 2009 to appoint a Chief Executive to lead and manage the trust operationally and a Chair to provide strong and independent strategic leadership. This was crucial at a time when the trust continued to face significant challenges, namely:
• the delivery of a demanding recovery plan which was required by Monitor following our first formal intervention at the trust in August 2008;
• a potential merger with another organisation (which has subsequently been postponed); and
• changes to tariff, which had the potential to impact on the future financial stability of the trust.
The trust developed a plan, which Monitor reviewed, that has succeeded in stabilising its position until its preferred long-term solution is in place.
Having demonstrated to Monitor that it had taken action to address our concerns, the trust was removed from significant breach in October 2010.
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.
For further background information on this intervention, please see the following reports: