Where our Board has deemed a trust to be in significant breach of its authorisation based on serious concerns about financial stability or governance at the trust, it will also then consider what regulatory action is appropriate. If a trust is deemed to be in significant breach, Monitor may use its statutory powers of intervention under Section 52 of the National Health Service Act 2006 (the Act).
The foundation trusts below have been found - and remain - in significant breach of their terms of authorisation. We continue to monitor their performance closely and to consider whether further regulatory action is necessary, including the use of our statutory powers of intervention.
The trust was found in significant breach of its authorisation in January 2012: General duty to exercise its functions effectively, efficiently and economically; and it's governance duty.
The Trust has experienced financial problems over the last year stemming from an ongoing failure to plan effectively and to address underlying performance issues. Having recorded a high financial risk for the first two quarters of 2011-12, the Trust subsequently failed to keep up with its financial recovery plan. Whilst the Trust is forecasting an improvement by the end of the financial year, it is important that this will be sustained into 2012-13.
The Trust will be kept under close scrutiny and required to report to Monitor regularly against the delivery of a robust recovery plan.
Read the letter sent to the trust’s chair on 20 January 2012 and Monitor's press release.
The trust was found in significant breach of its authorisation in January 2012: General duty to exercise its functions effectively, efficiently and economically; and it's governance duty.
The decision was based on the Trust’s financial performance and the challenges it is facing to improve its position during the next twelve months. Financial stability is vital to ensure that trusts can continue to meet the needs of patients.
Monitor’s on going scrutiny of the Trust raised concerns about its poor financial performance and future plans to address this. These issues were confirmed by an independent review that Monitor asked the trust to commission. The review indicated that the Trust’s Board does not have a strong enough role in scrutinising financial planning and performance.
Monitor is now requiring the Trust to commission external assurance to ensure that its concerns are addressed. This work will focus on ensuring:
Monitor will help to shape the scope of this work and will receive direct reports on its results.
Read the letter sent to the trust’s chair on 20 January 2012 and Monitor’s press release.
The trust was found in significant breach of its authorisation in December 2011: Governance duty; and healthcare and other standards duty.
The decision was triggered by the Trust’s on going failure to meet cancer and C.Difficile targets and by CQC concerns which resulted in the Trust being red rated for governance by Monitor in the first quarter of 2011/12. Following a period of scrutiny, Monitor has found that the Trust does not have an effective system in place to proactively identify and address risks or to establish whether risks relate to underlying governance issues. Monitor has concluded that this is evidence of weak governance.
The Trust will be subject to monthly meetings with Monitor until we are assured that the Trust is returning to full and sustainable compliance with its Authorisation.
Read the letter sent to the trust’s chair on 12 December 2011 and Monitor’s press release.
The trust was found in significant breach of its authorisation in November 2011: Governance duty; and healthcare and other standards duty.
The decision is triggered by the Trust’s failure to effectively address concerns raised by the Care Quality Commission (CQC) about the Trust’s compliance with standards for nutritional needs across some of its wards. The Trust will be kept under close scrutiny and will be required to report to Monitor on a regular basis against the delivery of key milestones which include the commissioning of an external review of its governance systems and processes.
Read the letter sent to the trust's chair on 25 November 2011 and the press release.
The trust was found in significant breach of its authorisation in November 2011: General duty to exercise its functions effectively, efficiently and economically; and it's governance duty.
The decision is based on risks identified by Monitor. In particular, the Trust has significant financial problems caused by its income being below planned levels.
The Trust will be required to report to Monitor on a monthly basis against the delivery of key milestones. It is required to share details of its proposals to improve the effectiveness of the Trust Board with Monitor. If Monitor does not think the Trust Board is delivering improvement quickly enough to return to full compliance with its Authorisation, Monitor will consider using its regulatory powers to intervene.
Read the letter sent to the trust’s chair on 17 November 2011 and the press release.
The trust was previously found in significant breach of three terms of its authorisation in February 2010: 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 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.
The trust was removed from significant breach in November 2010 after working with external experts to improve the function of its A&E department. The trust took appropriate steps to improve its A&E performance, its governance and the management of targets.
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 has been 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.
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 duty to remain financially viable. This was a result of concerns relating to the trust’s current financial position and the Board’s oversight of financial planning.
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 and Monitor’s press release.
The trust was found in significant breach of two terms of its authorisation in April 2011: the general duty to exercise its functions effectively, efficiently and economically and its governance duty. This was as a result of of an unplanned financial risk rating of 2 at quarter three and concerns around board level scrutiny and assurance processes concerning financial planning and performance.
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 27 April 2011.
In February 2011, the trust was found in significant breach of two terms of its Authorisation: the general duty to exercise its functions effectively, efficiently and economically and its governance duty. This was as a result of the trust delivering an unplanned financial risk rating of 2 at quarter two.
In May 2011, as a result of a planned review, CQC found one moderate and four minor concerns about how the trust was meeting essential standards of quality and safety. We are keeping in close contact with the trust and CQC to monitor progress on these issues.
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 1 March 2011.
In November 2010, the trust was found in significant breach of two terms of its Authorisation, namely the general duty to exercise its functions effectively, efficiently and economically, and its governance duty. This was as a result of the trust's failure to meet its financial plan at Quarter 1 2010/11; not ensuring appropriate resources and governance arrangements were in place to deliver the annual plan; and signing a contract which left the trust with an unacceptably high level of financial risk.
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 25 November 2010.
The trust was found in significant breach of a term of its authorisation in March 2010: its 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 concerns relating to effective, timely and pro-active design and implementation of maternity action plans, the effectiveness of board assurance processes, and board and clinical leadership.
During 2010/11, the trust's finances significantly deterioriated and it now has a financial risk rating of 1 (highest risk). The focus of Monitor's regulatory action is now on the trust's financial position and its quality governance.
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 3 March 2010 and the formal intervention notice on the NHS foundation trust directory.
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 a number of quality concerns including high Hospital Standardised Mortality Ratios (HSMR), persistent breaches of the Hygiene Code and the Care Quality Commission’s reviews of children’s services and learning disability services.
During 2010/11, a number of CQC planned and responsive reviews identified four moderate concerns and four minor concerns about how the trust is meeting essential standards of quality and safety. We are keeping in close contact with the trust and CQC to monitor progress on these issues.
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 26 November 2009 and the formal intervention notice on the NHS foundation trust directory.
The trust was found in significant breach of two terms of its authorisation in September 2009: its general duty to exercise its functions effectively, efficiently and economically and its healthcare targets and other standards duty. This was as a result of the trust’s failure to address persistent breaches of the A&E and Thrombolysis targets and weak financial performance.
In May 2011, as a result of a responsive review, CQC found two moderate concerns and four minor concerns about how the trust was meeting essential standards of quality and safety. We are keeping in close contact with the trust and CQC to monitor progress on these issues.
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 2 October 2009.
The trust was found in significant breach of a term of its authorisation in July 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 rapid decline in its financial and operational performance.
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 Chief Executive on 14 October 2009 and the formal 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 formal intervention notices on the NHS foundation trust directory.