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Department of Health publishes guidance for NHS Trust Special Administrators


A "Special Administrator" appointed to report on the potential restructuring of NHS Trusts must ensure that the interests of the patient come first throughout the process, according to new guidance from the Department of Health.

Publication of the document (28-page / 192KB PDF) follows reports that a south London trust responsible for the management of three hospitals could be the first to face the statutory procedure. A decision is expected later this week.

The guidance sets out five "principles" which should inform the administrator's decisions, dealing with accountability to patients, staff and state-owned providers. NHS Trusts are not, it says, "free-floating commercial organisations and the assets of state owners must be protected".

However, the guidance adds that the "most important" consideration is "the continued provision of high-quality, safe and effective services so that patients have the necessary access to the services that they rely on".

The guidance also sets out three possible outcomes the administrator could recommend to the Health Secretary including rescue, acquisition by or merger with another NHS Trust or Foundation Trust or dissolution, with services and staff transferred to another NHS Trust or Foundation Trust. The administrator may be appointed to stay on in order to implement the Health Secretary's final decision.

The Regime for Unsustainable NHS Providers was introduced in 2009 to provide a "time limited and transparent" framework to resolve problems in "significantly challenged" NHS organisations. The regime gives the Health Secretary the power to appoint a special administrator to review an NHS Trust if "appropriate in the interests of the health service". To use this power he must inform Parliament of the reason for his decision, after consulting with the trust and any regional health authority where the trust has hospitals or facilities. The entire process, from appointment of the special administrator to the Health Secretary's final decision, must take no more than 120 working days.

According to the guidance, the regime will only be used in "exceptional circumstances" where a trust is considered "unsustainable on a clinical, performance and/or financial basis". The Health Secretary will make a decision following advice from the chief executive of the NHS, based on the use of NHS Performance Framework and other performance management targets.

While the regime is in progress, the special administrator will be responsible for maintaining the provision of "safe and effective services", according to the guidance. The board of the Trust will no longer operate while the regime is running. The administrator will also develop and consult on a draft report and make final recommendations about what should happen to the organisation and its services as part of a final report to the Health Secretary.

The special administrator must produce a draft report, to be laid before Parliament by the Health Secretary, within 45 days of appointment. This report should be informed by consultation with the local health authority and commissioners, and the administrator should also consider whether to consult the public or staff.

A 30 working day consultation period must begin within five working days of the publication of the draft report, giving the administrator an opportunity to "validate and improve the recommendations", according to the guidance. The guidance calls for notice of the consultation period, and of mandatory public meetings, to be published. The administrator must also request written responses from health authorities and commissioners and hold at least one meeting with staff and union representatives during the consultation period.

Any responses received as part of this consultation process should be summarised as part of the administrator's final report in order to "ensure transparency", according to the guidance. This report must be submitted to the Health Secretary within 15 working days of the end of the consultation period. The Health Secretary will then have 20 working days to decide what action to take in relation to the organisation.

The guidance states that the special administrator's advice to the Health Secretary must be independent. Although the Health Secretary has powers to direct the administrator about "specific matters", including ensuring that certain relevant individuals and commissioners are consulted with, these powers do not extend to "amending the content" of the administrator's advice.

South London Healthcare NHS Trust was formed in 2009 by the merger of Princess Royal University Hospital, Orpington, Queen Mary's Hospital in Sidcup and Woolwich's Queen Elizabeth Hospital. The trust, which had a £69 million debt at the start of the financial year, inherited a large debt at the time of the merger primarily due to the private finance initiative (PFI) used in the construction of the buildings at Orpington and Woolwich.

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