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Monitor, the independent regulator of NHS foundation trusts, has recently published its review of NHS Foundation Trust (FT) performance for the fourth quarter 2011/2012.

At the beginning of 2011/12, Monitor identified a number of key challenges that could present significant risks for the foundation trust sector.  In the main, the sector continues to cope with these challenges.

Performance against waiting time targets for cancer had presented the most significant service challenge for foundation trusts in 2010/2011. Encouragingly, there was an improvement this year, with far fewer trusts breaching one or more cancer targets at Q4 (15 compared to 27 at Q4 2010/2011).

Improved delivery of cost improvement plans (CIPs) contributed to overall financial performance being slightly better then planned, however financial pressures will continue to be a dominating issue for trusts. The sector’s performance at the year end illustrates the downward trend of the last three years and conditions will remain challenging in the coming years.

Monitor had to use its regulatory powers on more occasions in 2011/12. The number of FTs in significant breach at the end of Q4 increased to 17 from 10 at Q4 last year, primarily driven by financial concerns. This is consistent with the downward trend in FRR and this year’s challenging health settlement.

Key points from the performance review include:

• Cost Improvement Plans (CIPs) were 5.7% below plan (an improvement from 7% below plan at Q4 2010/2011)

• The sector delivered £2.2 billion operating profit for 2011/2012. This was £77 million above plan. However, a small number of trusts are in significant breach for financial reasons.

• The average financial risk rating is (3.4), slightly above plan (3.2) (where 5 equals lowest risk, 1 equals highest risk)

• EBITDA margin at 6.1% is in line with plan (6.1%), but below last year (6.6%)

• Overall governance ratings were marginally worse than at Q4 last year. There was improved performance against some targets (C.difficile and cancer), but deterioration in others (RTT and A&E).

Commenting, Stephen Hay, Chief Operating Officer, Monitor said:

"On the whole this report paints an encouraging picture of how trusts have dealt with significant challenges over the last financial year. However, conditions will continue to be difficult in the coming years.

"As financial pressures continue in 2012, trusts will have to deliver robust plans if we are not to see more foundation trusts in significant breach for financial reasons.

"The improved performance against cancer targets is good news for patients, as is the reduction in the number of cases of C.difficile.  However, trusts will need to work harder on A&E performance and the Referral to Treatment (RTT) target."

Notes

1. For media enquiries contact Caroline Matlock, Media and Stakeholder Relations Manager, on 020 7340 2535.

2. Monitor authorises and regulates NHS foundation trusts ensuring they are well-managed and financially viable in order to deliver high quality healthcare for patients.

3. Monitor was established in January 2004. It is independent of government and accountable to Parliament. Monitor's functions and powers are set out in the National Health Service Act 2006.

4. This report reviews the performance of the 143 foundation trusts that were authorised as at 31 March 2012. There are currently 144 NHS foundation trusts.

5. Monitor assigns risk ratings to indicate the risk of a foundation trust failing to comply with its terms of authorisation in 2 areas (1) Finance (1 to 5 scale; a rating of 5 indicates the lowest risk of breaching the authorisation and a rating of 1 indicates the highest risk, in which case formal statutory intervention by Monitor is likely)) and (2) governance (traffic light rating system).

6. The full report can be found here: http://www.monitor-nhsft.gov.uk/home/browse-category/reports-nhs-foundat...

7. The risk ratings for all foundation trusts can be found here: http://www.monitor-nhsft.gov.uk/about-nhs-foundation-trusts/nhs-foundati...

8. Monitor is now on Twitter - follow us @MonitorUpdate