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Monitor urges foundation trusts to invest wisely to improve services for patientsRSS

Foundation trusts must ensure they are investing adequately in health services in order to protect patients interests, says health sector regulator Monitor.

Monitor is concerned following another sharp increase in the number of foundation trusts (FTs) failing to meet the national four hour A&E waiting times target in the last quarter.

Between January and March 2013, 47 foundation trusts failed to meet the A&E target, an increase on 32 in the previous quarter; meaning that over half (58%) of all FTs with A&E units breached their target. The number of foundation trusts failing national targets on cancer referral treatment waiting times also increased.

Reasons given by trusts included increases in the number and seriousness of A&E attendances, particularly among the elderly, discharge delays due to problems accessing community care services, and physical capacity constraints.

Performance improved in the first half of May, when FTs with A&E units achieved over 95%. However, Monitor is working with NHS England and the NHS Trust Development Authority to help all NHS trusts and local commissioners tackle problems with A&E, get back on track and plan effectively for next winter.
Stephen Hay, Managing Director of Provider Regulation said: "Our latest monitoring of foundation trusts shows that overall A&E performance worsened over the winter. We recognise that some of the causes and answers to this problem lie outside the control of individual organisations, particularly in primary care or social care.

"Trusts should therefore work with partners in their local health economy to tackle the issues affecting A&E, but should use their own resources to fix those issues that are within the gift of hospitals in order to prevent further problems next winter."

A report to Monitor's Board on performance in 2012/13 noted:

  • Performance on waiting times for elective treatment deteriorated, and in some cases FTs had to cancel elective work in order to deal with increased A&E activity and non-elective procedures;
  • High-bed occupancy rates associated with emergency care reduced the ability of trusts to tackle infection control, with more FTs (31) breaching C Difficile superbug targets;
  • The deterioration in performance against cancer targets was partly due to reductions in capacity associated with emergency pressures;
  • FTs significantly overspent by more than £500m on agency and contract staff due to higher activity, particularly in emergency care.

Monitor's report showed that a majority of foundation trusts are still not delivering the cost savings they said they would during the financial year. For the fourth quarter in a row, delivery was substantially behind plan, amounting to one-sixth of the £1.5 billion planned.

Overall the sector delivered a £540 million surplus in 2012/13, which contributed towards £4.5 billion in cash holdings at the end of the year, equivalent to one month’s operating costs in a sector with annual turnover of almost £40 billion.

Stephen Hay said: "Financially, foundation trusts are doing reasonably well, but they need to improve their planning, particularly for capital expenditure.

"Foundation trusts have the freedom to make a surplus every year as long as they plan to ensure that it is invested on behalf of patients. The amount they have stored up this year is well above what was expected, and we will encourage the sector to use its strong financial position to help ease capacity issues and continue to improve services for their patients."

Notes to editors

  • For media enquiries please contact Nick Burke, on 020 7340 2434 or (
  • The Performance of the Foundation Trust for 2012/13 report summarises the key trends drawn from individual reports of the 146 foundation trusts is available here.
  • The Monitor is the sector regulator of NHS funded health care services. Under the Health and Social Care 2012 Act its main duty is to protect and promote the interests of patients.
  • Information about Monitor's role can be found here.
  • Follow us on Twitter - @MonitorUpdate.


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