Monitor

Monitor determines whether NHS trusts are ready to become foundation trusts and operates a regulatory regime designed to ensure that the 147 trusts that have achieved foundation status continue to be financially sustainable, well-led and locally accountable. The number of NHS foundation trusts in difficulty is growing, casting doubt on Monitor's effectiveness as their regulator. Monitor estimates that 39 of 147 foundation trusts will be in deficit by the end of 2013-14. At 31 December 2013, 25 trusts (one in six) were in breach of the conditions set when they were awarded foundation trust status. These trusts were in financial difficulty, or had inadequate governance arrangements, or both, and Monitor expects the problems to grow. Some had been in breach of their regulatory conditions for over four years. Monitor should investigate quickly, to diagnose the underlying causes of the problems which each trust in difficulty faces, and then take faster, more decisive action to address them, to turn around failing trusts sooner.
There are potential conflicts between Monitor's traditional role of regulating NHS foundation trusts and the new responsibilities it has been given in the health sector. It is not clear whether the organisation can build the capacity to carry out effectively its expanded remit. Responsibility for overseeing the provision of healthcare is fragmented, and there is a strong risk of regulatory overlaps and gaps between Monitor and other bodies, including the Care Quality Commission, the NHS Trust Development Authority, NHS England and the Department of Health.