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The provider landscape and the role of the
regulator in improving provider resilience


        Presentation to Nuffield Trust
               4th December 2012


                   Mark Turner
            Regional Director, Monitor
Historical and projected performance
(2006 to 2015)

£billions                    %
 40                           9
 35                           8

 30                           7
                              6
 25
                              5   Total income (£ billions)
 20
                              4   operating costs (£ billions)
 15                               EBITDA (%)
                              3
                                  Net surplus (% income)
 10
                              2
  5                                Projected income
                              1    Projected operating costs
  0                           0




   05/12/2012                                                 2
FT Profit / Loss: Q1 2012 / 2013 –
Differential performance

                 Profit / loss (£m)
15.0



10.0



 5.0



 0.0



 -5.0                                 Profit / loss (£m)



-10.0



-15.0



-20.0



-25.0

   05/12/2012                                              3
Regulatory action


                                % of FT sector in significant breach
    14.0%

    12.0%

    10.0%

     8.0%
                                                                                                                                                        Finance

     6.0%                                                                                                                                               Governance
                                                                                                                                                        Total
     4.0%

     2.0%

     0.0%
                Q1      Q2      Q3      Q4      Q1       Q2      Q3      Q4     Q1       Q2      Q3      Q4     Q1       Q2      Q3      Q4     Q1
              2008/09                         2009/10                         2010/11                         2011/12                         2012/13




               36 FTs have been found in significant breach since 2004
               11 FTs in the past year

Note: Analysis on this slide excludes Bradford significant breach decision (2004). There were no other significant breach decisions before Q1 2008/09

           05/12/2012                                                                                                                                                4
Monitor’s responsibilities


                      Health and Social Care Act 2012



                                  Monitor:
              protect and promote interests of people who use
                            health care services



     FT                           Choice and        Integrated   Continuity
                   Pricing
 Governance                       competition          care      of services




                    Enabled through the New Provider Licence


 05/12/2012                                                                    5
Approach to potential failure



Causes of failure             Monitor actions

                              •   Contingency planning team works
                                  with local commissioners .
• Management / clinical
  management failure          •   While drawing up plans, solution
                                  may be found that would result in
                                  provider avoiding financial failure
• Underlying viability of
  individual provider         •   Provider placed into special
                                  administration if solvent
• Configuration of services       restructuring is not possible
  across health economy
                              •   Risk Pool will provide funding to
                                  ensure continuity of service whilst a
• Change in demand                permanent, sustainable solution is
                                  found.


 05/12/2012                                                               6
Monitor’s focus – key challenges



                     Maintain         New
                   assessment      regulatory
                    ‘high bar’     framework


               Key sector                  CIPs and
              risks - PFIs,                 Quality
               LHE, DGHs

                            Solutions
                          to financially
                           distressed
                            providers



 05/12/2012                                           7
The provider landscape and the role
   of the regulator in improving
        provider resilience

   Presentation to Nuffield Trust
        4th December 2012



               Mark Turner
        Regional Director, Monitor

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Mark Turner: The provider landscape and the role of the regulator in improving provider resilience

  • 1. The provider landscape and the role of the regulator in improving provider resilience Presentation to Nuffield Trust 4th December 2012 Mark Turner Regional Director, Monitor
  • 2. Historical and projected performance (2006 to 2015) £billions % 40 9 35 8 30 7 6 25 5 Total income (£ billions) 20 4 operating costs (£ billions) 15 EBITDA (%) 3 Net surplus (% income) 10 2 5 Projected income 1 Projected operating costs 0 0 05/12/2012 2
  • 3. FT Profit / Loss: Q1 2012 / 2013 – Differential performance Profit / loss (£m) 15.0 10.0 5.0 0.0 -5.0 Profit / loss (£m) -10.0 -15.0 -20.0 -25.0 05/12/2012 3
  • 4. Regulatory action % of FT sector in significant breach 14.0% 12.0% 10.0% 8.0% Finance 6.0% Governance Total 4.0% 2.0% 0.0% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 2008/09 2009/10 2010/11 2011/12 2012/13  36 FTs have been found in significant breach since 2004  11 FTs in the past year Note: Analysis on this slide excludes Bradford significant breach decision (2004). There were no other significant breach decisions before Q1 2008/09 05/12/2012 4
  • 5. Monitor’s responsibilities Health and Social Care Act 2012 Monitor: protect and promote interests of people who use health care services FT Choice and Integrated Continuity Pricing Governance competition care of services Enabled through the New Provider Licence 05/12/2012 5
  • 6. Approach to potential failure Causes of failure Monitor actions • Contingency planning team works with local commissioners . • Management / clinical management failure • While drawing up plans, solution may be found that would result in provider avoiding financial failure • Underlying viability of individual provider • Provider placed into special administration if solvent • Configuration of services restructuring is not possible across health economy • Risk Pool will provide funding to ensure continuity of service whilst a • Change in demand permanent, sustainable solution is found. 05/12/2012 6
  • 7. Monitor’s focus – key challenges Maintain New assessment regulatory ‘high bar’ framework Key sector CIPs and risks - PFIs, Quality LHE, DGHs Solutions to financially distressed providers 05/12/2012 7
  • 8. The provider landscape and the role of the regulator in improving provider resilience Presentation to Nuffield Trust 4th December 2012 Mark Turner Regional Director, Monitor