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Fears over lack of nurse oversight in rush for foundation trust status

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Concerns have been raised about a lack of nursing expertise at the body responsible for approving applications by NHS trusts to attain foundation status.

The Royal College of Nursing has warned that the foundation trust regulator Monitor should appoint a senior nurse adviser to help prevent Mid Staffs-style care failures.

One of the main reasons cited for the failings at Mid Staffordshire Foundation Trust was that its board of directors became too focused on the financial requirements of becoming a foundation, at the expense of patient care.

RCN head of policy development Howard Catton told Nursing Times he had “concerns” about the lack of nursing expertise within Monitor, in light of the government’s deadline for all NHS trusts to achieve foundation status by 2014.

He said: “If organisations are squeezing clinical services to the point where there are question marks over quality and safety – and they are doing that in order to achieve FT status – where is the clinical advice to Monitor?”

He added: “I think those are very real concerns now that FT status is a matter of organisational survival for trusts.”

“The worst-case consequences of the drive to FT status are there in terms of Mid Staffs,” he warned.

The Francis report into substandard care at Mid Staffs, published last year, said the trust’s board had approved substantial cuts to the nursing workforce without professional advice about the impact of the reduction.

A Monitor spokesman confirmed there were currently no qualified nurses on Monitor’s board but said: “We have previously had directors with a clinical background and there is nothing to prevent someone from a nursing background applying for a role on Monitor’s board.”

He added that, following Mid Staffs, Monitor had enhanced the way it assessed quality governance at applicant trusts and worked closely with care regulator the Care Quality Commission.

Mr Catton welcomed the work Monitor had done, but said he would like to see the regulator “face that risk proactively by appointing someone from a nursing background to a senior level within the organisation, rather than the more voluntary approach they have suggested”.

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Readers' comments (2)

  • Whilst the RCN in the form of Mr Catton’s concerns about nursing representation on Monitors Board is better late than never surely the primary and far more urgent concern is the quality of the professional advice being offered by Director of Nursing?

    “The Francis report into substandard care at Mid Staffs.. said the trust’s board had approved substantial cuts to the nursing workforce without professional advice about the impact of the reduction”

    Beef up the safety net by all means, but don’t ignore the root cause of the problem which is the quality of the contribution being offered by many (not all) Directors of Nursing.

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  • it seems that hospital managers make decisions about patient care without understanding the importance of seeking the professional advice of nurses before making decisions. it seems that this may also apply to the proposed government changes for the nhs as well. their role is planning based on logistics and strategies but they lack knowledge and insight of the practicalities and fail to take into consideration the individual variations in the needs and demands of the patients their organisation is supposed to be caring for.

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