REGULATION
107. Following authorisation, FTs are subject
to monitoring of finance and performance by Monitor:
Monthly and quarterly returns on finance and performance
are rigorously scrutinised and deviation from plan can lead to
changes in the "traffic light" performance indicators.
Deterioration in performance leads to increased scrutiny, visits
and enforcement to ensure plans are created and implemented to
correct deviations from plans.[79]
108. In addition to this, FTs must also report
data to the Healthcare Commission's Annual Healthcheck in the
same was as other NHS trusts. According to Alan Maynard, Monitor
seems well regarded, and "is generally more visible to hospitals
than the Healthcare Commission."[80]
Monitor recognises the importance of good relations with the HCC
and now discussing how it will work with the CQC. However, questions
remain about whether it is necessary for FTs to be subject to
quality monitoring by two separate regulators. A further layer
of complexity will be added by the proposed establishment of a
further regulator, the Competition and Collaboration Commission,
which will act as an 'OFT' equivalent for the NHS. With Monitor
alone costing around £13m per annum[81],
not taking account of the costs of regulation to NHS trusts, whether
these regulatory bodies are providing the necessary regulatory
support to the NHS as efficiently as possible requires close scrutiny.
109. A further concern about the way in which
FTs are regulated is that less information is centrally collected
under current system, and so less information on FTs may be available
for the purposes of public scrutiny and research. Marini et
al report difficulties in their research on the impact of
FTs. Professor Goddard informed us that :
In trying to undertake independent evaluation of
the impact of FTs, we encountered some problems in the availability
of data from FTs. In the past, all NHS trusts have been required
to submit financial returns to the Dept of Health in a common
format (known as TFRs—Trust Financial Returns) and these
are available in the public domain. However, as part of the freedoms
given to FTs they are no longer required to submit this data …
Monitor said that some of their returns would contain information
we were seeking but that they were unable to let us have this
data because it was confidential. Their suggestion was that we
seek permission from every FT in order that the data could be
released… that is rather time consuming and not conducive
to the conduct of independent evaluation. Ultimately we were able
to get the Foundation Trust Network to assist us in getting permission
but it was made clear that if we wished to update the analysis
with more recent financial data we would be required to approach
each FT directly.
The increasing mis-match between the format and nature
of the data provided by the FTs and non-FTs makes proper comparisons
impossible …CIPFA[82]
has cut down the data series they have usefully produced on Trusts
over many years. Our own rich series of data on NHS Trusts which
we have assembled in the Centre for Health Economics over many
years (covering input, output and process variables), which has
facilitated a range of useful research projects, has also fallen
down because of the lack of FT data held in the public domain.
As more Trusts become FTs, less and less information will be available
for research purposes. As FTs remain public sector organisations
spending public funds, it is worrying that independent scrutiny
of some fundamental issues is made difficult, or even impossible,
by rules that seem to protect them as commercial concerns.[83]
110. When we put the researchers' concerns to
Dr Moyes, he replied that data was still accessible, but conceded
that it was more difficult for researchers to put together than
previously.[84]
111. The FT application process
and regulatory regime seems to be well regarded, but concerns
have been expressed about the availability of information on FTs
for the purposes of public scrutiny and research. There also seems
to be potential duplication between Monitor and the Healthcare
Commission in terms of regulating quality, and the regulatory
landscape will soon be further complicated with the addition of
a new body, the Competition and Collaboration Commission.
69 
