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Review of the contingency planning team/trust special administration procedure at Mid Staffordshire NHS Foundation Trust: lessons learned

Mid Staffordshire NHS Foundation Trust was the first organisation to go through the new regulatory enforcement procedure for NHS foundation trusts that was introduced under the Health and Social Care Act 2012. Monitor appointed a contingency planning team (CPT) to assess the trust’s clinical, financial and operational sustainability in October 2012, and on the basis of its report appointed Trust Special Administrators (TSAs) to oversee the management of the trust while implementing a long-term solution for local patients. The outcome, approved by the Secretary of State for Health, was that Mid Staffordshire NHS Foundation Trust was dissolved in November 2014 and most of its services taken over by neighbouring NHS trusts.

Although a viable solution was identified and implemented in this case – and this was done more quickly than has typically been the case where similar changes have been required elsewhere – nonetheless, the work of the CPT and the trust special administration took longer than anticipated, encountered several hurdles, and entailed considerable public expense (see the published costs reports). Throughout the period Monitor continually reviewed the CPT and trust special administration procedures at Mid Staffordshire NHS Foundation Trust and learned important lessons from the experience. Our enforcement team has applied these lessons to commissioning and managing four subsequent cases where NHS foundation trusts have become unsustainable. Three of these involved appointing a CPT, but none has yet required TSAs.

This report describes the lessons Monitor learned from the regulatory procedure at Mid Staffordshire NHS Foundation Trust, the actions we have taken to apply these lessons, and how that experience is informing the pre-emptive approach we now follow to help organisations in struggling local health economies avoid chronic difficulties. The lessons fall under six broad headings:

1. Taking a local health economy-wide approach from end to end

2. Engaging early with national partners and local stakeholders

3. Building consensus locally to avoid the need for a trust special administration

4. Allocating more resources to local communications and engagement

5. Anticipating the needs for sufficient investment in the failing organisation during the process

6. Managing external suppliers more effectively.