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