A directory of organisations published by financial watchdog Monitor reveals that 17 foundation trusts involved in vanguard schemes are rated at 'high risk' of becoming financially unviable or are being investigated for governance problems.
The directory gives 12 trusts a 'red' governance rating - indicating that Monitor has concerns about how the organisation is being run, and is taking enforcement action. Two of these organisations also have the highest possible risk rating for continuity of care - meaning Monitor is concerned the trust could 'fail to carry on as a going concern' because of its financial situation.
A further three foundation trusts in vanguard schemes are 'under review', and two others have no governance concerns but are in the highest risk category for their financial situation and threat to continuity of care.
NHS England new care models programme director Samantha Jones said: 'We are working closely with all of the organisations involved in the vanguard programme and providing them with support to make the ambitious changes they have each outlined.'
Wessex LMCs chief executive Dr Nigel Watson told GPonline that many of the organisations were involved in vanguard schemes exploring new models of care precisely because of the financial and organisational pressures they face.
Southern Health NHS Foundation Trust, a partner in the South Hampshire vanguard scheme that Dr Watson chairs, is among trusts facing a governance review by Monitor.
Dr Watson said: 'Quite a lot of trusts are reporting gaps between their funding and what they have to deliver. When you look at some health economies that are better funded, there may be less need there for transformation.
'We are looking at our situation and it is increasingly unsustainable. Part of it is a system problem - money and resources are in the wrong place - and part of it is that services need to be transformed.'
This, Dr Watson said, meant organisations facing difficulties were more likely to explore changes. Negative situations could then be turned around because they force NHS organisations to find solutions. 'We are on a burning platform,' he said. 'If the only people allowed to take part in the vanguards were those with more money, there would be no point to it.'
A Monitor spokesman said: 'To meet the many challenges it faces, the NHS needs to develop ways to provide better patient care at the same time as becoming more efficient and offering better value for money in the long term. The vanguard sites are taking the lead on developing innovative new models of care to address those challenges, using the expertise of local clinical frontline staff to redesign how people receive care in their area.
'Many trusts around the country are under exceptional pressure. Vanguard sites were selected in part on the basis of their track record for partnership working and their ability to develop and implement their proposals at pace. This doesn’t remove the need for those organisations to maintain a focus on delivering safe and affordable care to patients. We will continue to work with providers to ensure that they are able to maintain an appropriate balance of focus on short and long-term challenges.'
Photo: JH Lancy