The BMJ Today: Honey, I shrunk the health service

If the blistering analysis article posted today on is correct, then foundation trusts (FTs) need to prepare for a cut in the NHS funded services they are legally obliged to provide. This reduction in “mandatory” core services could come as soon as 2016 for some FTs. It matters, say the authors, because the fewer services NHS trusts are required to provide, the less comprehensive our health service becomes. 

But why might hospital services be reduced? The authors, barrister Peter Roderick and a leading health academic, Professor Allyson Pollock, report that service commissioners have been told by health regulator Monitor to draw up a list of core services that “would need maintaining if a foundation trust was unable to pay its debts.”

With 86 out of 147 foundation trusts currently in the red, bankruptcy must be taken seriously.

The risk is that this core list of services that must be provided if a trust is in financial difficulty becomes the new “normal” list of mandatory services trusts must provide, even if they are not in financial trouble, the authors warn.

“The effect will be to reduce NHS funded care to a basic package of services equivalent to those that must be provided in the event of foundation trust failure,” they say. They question if this is even legal.

Health regulator Monitor seems to have few friends. The organisation is top heavy with management consultants but clinicians are as rare as hen’s eggs (it employs only seven).

Unfortunately, many of these decisions about what are essential services will in effect be made by management consultants. Monitor, the article shows, spent nearly £33m on six management consultant firms in the two years after the 2012 Health and Social Care Act, with Ernst and Young taking home just over a third of that amount.

Pollock and Roderick liken Monitor to an octopus: “Now its tentacles are extending with government approval to overruling commissioners, to planning for failure, and to reducing NHS-funded care to a basic package of services. Time will tell how far its tentacles can lawfully extend.”

Rebecca Coombes is magazine editor, The BMJ.