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The number of NHS foundation trusts in difficulty is growing, casting doubt on Monitor's effectiveness as their regulator. At the time of our hearing Monitor estimated that 39 of 147 foundation trusts would 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. Furthermore 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. At present Monitor relies heavily on consultants and 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's role and those of other bodies, including the Care Quality Commission, the NHS Trust Development Authority, NHS England and the Department of Health.
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