Recommendation 31

Routine monitoring and inspection to lead to coordinated intervention when necessary

Where aware of concerns that patient safety is at risk, Monitor and all other regulators of healthcare providers must have in place policies which ensure that they constantly review whether the need to protect patients requires use of their own powers of intervention to inform a decision whether or not to intervene, taking account of, but not being bound by, the views or actions of other regulators.

We agree that where routine monitoring and inspection identifies risks to patients’ safety, regulators must be able to intervene swiftly and in a coordinated way that promotes joint action as part of a single failure regime (see recommendation 19).

In April 2013 a network of local and regional quality surveillance groups was established that brought together commissioners, regulators, local Healthwatch representatives and other bodies on a regular basis to share information and intelligence about quality across the system, including the views of patients and the public.  Quality surveillance groups help to proactively spot potential problems early on and coordinate any action that is needed to respond where risks to patients are identified.  Where potential concerns arise of a serious failure, members of the quality surveillance groups will be able to act quickly by triggering a risk summit. All quality surveillance group members relevant to the provider in question attend these summits so that they can, together, give specific, focused consideration to the concerns raised and develop a joined-up response.

As part of its regulatory model, the Care Quality Commission monitors evidence and information to detect if a provider is performing outside of what would be expected.  This includes the monitoring of a small set of key measures that have a high impact on people and can alert the Care Quality Commission to changes in those areas.  These include mortality rates, never events, results from staff and patient surveys, information from whistleblowers, comments from patients and the public on the quality of care, and information from quality surveillance groups.  Any indicator within that set which points to a potential concern will trigger a response from the Care Quality Commission depending on the concerns raised.  This may vary from asking the Trust for further information and an explanation to conducting an inspection or, in extreme cases, the suspension of a service.  On 24 October 2013, the Care Quality Commission published for the first time surveillance data for all acute trusts as part of its new regulatory regime.  For further details on the Care Quality Commission’s new inspection and surveillance programme see the responses to recommendations 20, 50 and 51.

The NHS Trust Development Authority published Delivering High Quality Care for Patients which outlines the oversight model that will use to hold non-foundation trusts to account for their performance.  Where necessary, the NHS Trust Development Authority will directly intervene by requesting recovery plans and additional reporting, increasing engagement with the organisation, commissioning ‘deep dive’ investigations into a trust’s performance, reviewing the skills and competency of the board, and commissioning interim support to provide additional management capacity.

For NHS foundation trusts, Monitor will continue to assess breaches to its licence system that sets conditions covering financial viability and governance as well as other areas that reflect Monitor’s expanded role within healthcare.  Monitor’s licence conditions include compliance with health care standards specified by the Secretary of State for Health, the Care Quality Commission, NHS England and statutory regulators of healthcare professions.To do this, Monitor uses a risk based system of regulation that determines the intensity of monitoring required for each foundation trust.  Where Monitor determines that a Foundation Trust has breached its licence it may impose additional conditions to resolve any concerns including where the Care Quality Commission has issued a warning notice to a foundation trust.  These are in addition to Monitor’s powers to apply discretionary requirements or seek enforcement undertakings from a provider that has breached its licence. Monitor also has a formal weekly process to review the need for intervention and, if required, calls urgent special meetings to take a formal decision to intervene where patient safety might be at risk. Decisions are closely informed by the views and actions of the Care Quality Commission but are not bound by them.


Under the new special measures regime, the NHS Trust Development Authority and Monitor are now able to intervene at providers which the Care Quality Commission judge to be providing poor quality care as part of their new inspection programme. This includes partnering the failing provider with a high-performing buddy, the appointment of a dedicated Improvement Director at the trust as well as other targeted interventions to ensure rapid improvements where failings have been identified.