Intended for healthcare professionals


A wolf in sheep’s clothing: how Monitor is using licensing powers to reduce hospital and community services in England under the guise of continuity

BMJ 2014; 349 doi: (Published 07 October 2014) Cite this as: BMJ 2014;349:g5603
  1. Peter Roderick, barrister and senior research fellow1,
  2. Allyson M Pollock, professor1
  1. 1Global Health, Policy and Innovation Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London E1 2AB, UK
  1. Correspondence to: A M Pollock a.pollock{at}
  • Accepted 21 August 2014

Peter Roderick and Allyson M Pollock argue that the licence conditions imposed by Monitor on NHS foundation trusts will lead to a reduction in hospital services, and they question the legality of Monitor’s approach

Market forces and budget cuts are challenging the financial viability of hospitals in England, with NHS beds and other services continuing to close as thousands of staff are laid off.1 However, a further challenge to a comprehensive health service has received less publicity—an expected reduction by April 2016 in the services that NHS foundation trusts are legally obliged to provide. The reduction is a consequence of provisions in the Health and Social Care Act 2012 that have led to a change in the conditions imposed on foundation trusts.

Monitor’s new powers

NHS foundation trusts were introduced in 2003 under conditions set out in “authorisations” from the regulating body, Monitor. The authorisations designated certain services as mandatory—that is, foundation trusts were obliged to provide them. The 2012 act replaced authorisations with licences issued by Monitor, and since April 2014 these licences have applied to commercial and voluntary sector providers as well as to foundation trusts.2 Monitor’s register shows about 147 foundation trusts3 and 96 private providers licensed by the end of May 2014.4

The 2012 act extends Monitor’s powers by allowing it to impose licence conditions to ensure “the continued provision of health care services.” It can require trusts to provide specific services and give notice if they intend to stop providing a service. Licences extend to the use and disposal of land, buildings, and equipment, and the making of investments. If Monitor imposes these conditions, it “must carry out an ongoing assessment of the risks to the continued provision of services.” Monitor can also require licence holders to provide information to service commissioners, allow Monitor …

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