When an NHS foundation trust has breached, or is at risk of breaching, its terms of authorisation Monitor will require it to explain why. We will then require an action plan setting out how it plans to resolve the problem. In certain cases Monitor’s Board will find an NHS foundation trust to be in significant breach of its authorisation.
When a foundation trust is able to demonstrate that it has taken action to address the concerns which led to the significant breach, Monitor’s Board will consider removing the foundation trust from significant breach. The foundation trusts listed below have satisfied Monitor’s Board that they are no longer in significant breach of their terms of Authorisation*.
The Trust was found in significant breach in July 2010 due to a failure to comply with its general duty to exercise functions effectively, efficiently and economically, and its governance duty. Monitor uses the term governance to describe the overall effectiveness of a foundation trust’s leadership.
Since being found in significant breach the Trust has been under close scrutiny from Monitor and required to report formally to us on their progress. During this time the Trust has substantially improved its financial position and is forecasting a surplus for 2011/12. The Trust has also addressed its governance issues, and an independent review concluded that the trust has stronger leadership at Board level and Non-Executive Directors are providing more effective challenge.
The trust was found in significant breach of a term of its authorisation in October 2009, due to a failure to comply with its general duty to exercise its functions effectively, efficiently and economically. This was as a result of a deterioration in financial performance and operational efficiency.
After being found in significant breach the Trust has achieved a steady improvement in financial performance. Having reported a deficit in 2009/10 and 2010/11, the Trust is forecasting a surplus for 2011/12. The Trust also demonstrated improvements in governance; the Trust’s Board membership has changed significantly and there is evidence of improved Board level assurance and oversight of financial information.
The trust has demonstrated considerable progress towards addressing our concerns and that it has robust plans in place to continue to do so. Monitor’s Compliance Board Committee took the decision to remove the trust from significant breach in November 2011, as there was sufficient evidence of a sustainable improvement in financial performance and governance.
The trust was found in significant breach of two terms of its authorisation in February 2010: its governance duty and its healthcare targets and other standards duty. This was as a result of governance concerns related to persistent breaches of the A&E target.
Monitor required the trust to put in place measurable plans to achieve the A&E target and to improve the governance structures in place to ensure performance is sustained.
Since the trust was found in significant breach, A&E performance has improved and the trust has worked with external experts to improve the functioning of the A&E department. The trust has taken appropriate steps to improve governance and the management of targets, and as a result of the progress it has made, the trust was removed from significant breach in December 2010.
The trust was found in significant breach of three terms of its authorisation in December 2009: its general duty to exercise its functions effectively, efficiently and economically, its governance duty and its healthcare targets and other standards duty. This was as a result of a persistent failure to address governance concerns and the delivery of the A&E target.
The trust appointed a new Chief Executive in October 2009 to provide operational leadership. The trust met the A&E target during quarter four of 2009-10 and engaged advisers to improve the way in which its board functions. Monitor held regular meetings with the trust board to track improvements in both these areas against key performance indicators agreed with the trust.
The trust has since demonstrated considerable progress towards addressing our concerns and that it has robust plans in place to continue to do so. While a number of challenges remain, Monitor’s Board took the decision to remove the trust from significant breach in December 2010, as there was sufficient evidence of a sustainable improvement in governance in relation both to the A&E access target, and more broadly to governance as whole.
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.
The trust was found in significant breach of three terms of its authorisation in November 2009: its general duty to exercise its functions effectively, efficiently and economically, its governance duty and its healthcare targets and other standards duty. This was as a result of evidence of poor planning, a persistently high HSMR, poor national survey results and breaches of A&E, 18 weeks and cancer targets, and MRSA screening.
Monitor used its formal powers of intervention, at the same time as finding the trust in significant breach, to remove the trust Chair and appoint Sir Peter Dixon as Interim Chair.
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.
The trust was found in significant breach of its terms of authorisation on 27 January 2010 due to governance concerns and its A&E performance.
After the trust was found in significant breach, it was required to improve its focus on emergency care, and also to improve the governance structures in place, and this has led to an improvement of the trust’s position. In July 2010, the trust was removed from significant breach as a result of the progress it has made.
The trust was found in significant breach of its terms of authorisation on 29 July 2009 due to governance concerns and its MRSA performance.
Subsequently the trust breached its terms of authorisation due to 18 weeks and A&E performance. In addition, following the resignation of three NEDs, further general governance concerns arose in relation to board effectiveness. This has precipitated a turnaround at the trust with new NEDs being recruited and improvements in the governance structures in place at the trust. Healthcare targets for MRSA, A&E and 18 weeks have come back into compliance.
After the trust was found in significant breach, it was required to improve its focus on healthcare standards, and also to improve the governance structures in place, and this has led to the turnaround of the trust’s position. In June 2010, the trust was removed from significant breach as a result of the progress it has made.
On 24 June 2009, Monitor deemed the trust to be in significant breach of its authorisation due to governance concerns relating to its C. difficile performance and assigned it a red rating for governance risk in Q4 2008 – 09.
Having demonstrated to Monitor that it had taken action to address these concerns and in particular to achieve its 2009-10 target, the trust was removed from significant breach and rated amber for governance risk at Q3 2009-10.
On 29 April 2009, Monitor deemed the trust to be in significant breach of its authorisation due to governance concerns relating to both its MRSA and C. difficile performance and assigned it a red rating for governance risk in Q3 2008 – 09.
Having demonstrated to Monitor that it had taken such action to address these concerns and in particular to achieve its 2009-10 target, the trust was removed from significant breach and rated amber for governance risk at Q3 2009-10.
On 29 April 2009, Monitor deemed the trust to be in significant breach of its authorisation due to governance concerns relating to its MRSA performance and assigned it a red rating for governance risk in Q3 2008 – 09.
Having demonstrated to Monitor that it had taken action to address these concerns and in particular to achieve its 2009-10 target, the trust was removed from significant breach and rated amber for governance risk at Q3 2009-10.
*Trusts listed above were removed from significant breach between 2 March and 15 December 2010. The list is updated when a trust is removed from significant breach.