Monitor – monitoring or neglecting?

Antonyms for monitoring: ignore, neglect, forget (Roget’s 21st Century Thesaurus, Third Edition Copyright © 2013 by the Philip Lief Group



Jim Mackey, Chief Executive of Monitor



Monitor was the first Regulator or Commissioner to respond to my open emails of 10 January and 24 January 2016. On 27 January, Tom Grimes of Monitor emailed:

“Thank you for your email. Sorry we have not yet responded to your email of 10 January. I am in discussions with CQC and NHS England and hope to be responding shortly.”

Are the CQC, NHS England and Monitor not capable of responding individually? It is innately suspicious that they need to collude over explaining their own lack of action.

It is perverse of them to liaise in their own interests (and that of the NHS) but conversely refuse to liaise when it is in patients’ interests to do so. Commissioners and Regulators regularly refuse to act and refer complainants to another organisation without even a supporting letter.

It makes a mockery ofThe Statement of Common Purpose, pages numbered 9 and 10 in Patients First & Foremost, published by The Department of Health in March 2013. The CQC, Monitor and NHS England all signed up to a number of undertakings: three undertakings are sufficient to demonstrate my point:

“Patients come first in everything we do. We fully involve patients, staff, families, carers communities, and professionals inside and outside the NHS. We put the needs of patients and communities before organisational boundaries. We speak up when things go wrong.”

“We will put patients first, not the interests of our organisations or the system. We will listen to patients, striving to ensure the quality of care that we would want for ourselves, our own families and our friends.”

“We will work together, collaborating on behalf of patients, combining and coordinating our strengths on their behalf, sharing what we know and taking collective responsibility for the quality of care that people experience. Together, we will be unfailing in rooting out poor care and unflinching in promoting what is excellent.”

The Secretary of State for Health should tear up ‘The Statement of Common Purpose’ and start all over again. The CQC, Monitor, NHS England (and other signatories) do not put patients first or fully involve them; organisational boundaries are akin to a re-enforced Berlin Wall; and they refuse to speak up if things go wrong – they just refer patients elsewhere without even a supporting letter.

Eventually, Monitor did respond on its own: here are some extracts of Tom’s letter with comments:

“We have now decided to issue our own response, which has been seen by Jim Mackey’s office, but in accordance with our earlier communications, is from me as your single point of contact at Monitor.”

At Monitor, I addressed my open emails primarily to John Mackey,  CEO – , yet apparently only his “office” saw it. In the commercial sector, if a customer writes to the CEO, the CEO replies in person: British Airways and Tesco are good examples. Clearly, they do not investigate complaints personally – or even draft the response – but at least they show interest by replying under their personal signature.

Is Mr MacKey too important to respond in person after such a 25-year career as an NHS Director? To paraphrase ‘The Statement of Common Purpose’, he is supposed to put patients first in everything he does.

“In your email you ask why the regulators are not engaging with ex-patients and family groups affected by the report produced by Mazars.”

That’s evasive: I asked, why they didn’t send observers to Board and Council of Governors meetings – especially as the two meetings in question were Extraordinary Meetings relating to the Mazars Review.

“The trust has also agreed to work with an Improvement Director, appointed by Monitor, who will use their expertise to support and challenge the trust as it fixes its problems.”

Well that’s alright then but where is this Improvement Director? Even now, Monitor is unable to provide information about the recruitment process, much less a name and proposed start date.

“The Improvement Director will attend the trust’s board meetings, but Monitor does not usually attend these meetings as we have other means of oversight of the trust. Specifically, we meet members of the trust board for formal progress review meetings every 4-6 weeks at which we hold them to account for progress against our regulatory requirements. However, Monitor did attend the governors’ meeting on 26 January 2016 at their request.”

Monitor admits it does not attend meetings as observers, even Extraordinary Meetings called for the specific purpose of discussing the Mazars Review, unless formally invited by the Trust to do so. Even on 26 January, he/she kept a low profile in mixing with patients and family members prior to the meeting.

“I am aware the trust is engaging with patients and families affected by the Mazars review.”

I suspect Dr Sara Ryan (and many others) will not agree.

 “We also appreciate that current and previous service users and their families want to know what is happening with the trust from a regulatory perspective and have their views heard. We work closely with local Healthwatch groups, which have a key role in representing the views of patients in their area and attend regular Quality Surveillance Groups meetings, with us, CQC and NHS England. Local Healthwatch have also attended the risk summits relating to Southern Health specifically. This gives us some useful insight into patient opinion regarding the trust.”

 Again, all are representatives funded by the taxpayer with service users excluded.

“As with other foundation trusts, where we receive concerns from service users and carers about a trust, we use that information, where relevant, to inform our regulatory approach.”

“If any of the families affected by the Mazars report wish to share their views they can do so using the following contact details: or 0203 747 0900.”

This is misleading: 0203 747 0900 is just Monitor’s general enquiries line: it is nothing special.

“In your email you have provided details of what you say are un-investigated incidents that occurred while you were an inpatient in 2011. However, as you are aware, we are not in a position to resolve individual matters, which are for the trust to consider and look at under its complaints procedure if it considers it appropriate.”

Ha, ha – so the incidents are for Southern Health to investigate: they refused.

“The issues you raise do not raise governance concerns for us that indicate a breach or potential breach of the trust’s licence that would warrant investigation by us over and above that which we are already taking action.”

“They are potentially relevant to the CQC in its capacity as the quality and safety regulator, but at your request we have not shared this email with them and I know you have been in contact with the CQC very recently.”

Up goes the Berlin Wall again! Monitor admits to not sharing evidence of serious un-investigated incidents with the CQC. Is this the same Monitor that undertook inter alia to work together with other bodies to collaborate on behalf of patients, share what they know and take collective responsibility for the quality of care that people experience? Surely not!

It is a fact also that Regulators take complaints more seriously if they come from other Regulators or employers – this includes Monitor and the General Medical Council. 

At decide if you believe these are incidents of which Monitor should be aware.

One of the incidents is an allegation of unlawful conduct but Tom goes on to contradict himself:

You have also alleged that you have evidence of breaches of the law by trust directors. As I have explained, if you have any genuinely new information that we have not yet seen that is relevant to our role, please send it to us and we will consider it.”  

Tom conveniently overlooks that un-investigated incident (1) is an alleged breach of the law.

This is a standard response to written complaints. Monitor knows very well I am not prepared to waste more time putting anything else in writing unless they show they are serious – by meeting. I can then talk them through the evidence and give them copies. However, Tom goes on to write: 

“However, we do not currently think that a meeting with you is necessary.

I suspect the hidden meaning is they don’t want a meeting in case it actually means they have to do something.

In fact Tom and a colleague did meet me once. On 17 October 2013, they spent half-a-day (or more) travelling to Southampton – just to tell me they could not do anything – thereby wasting my time and taxpayers’ money too.

But when a patient has evidence of something on which they could apparently take action, they refuse to meet. Enough now of Monitor – more may follow at a later date.

© Monitor/Department of Health.

1 thought on “Monitor – monitoring or neglecting?

  1. Pingback: Katrina Percy – “Bad at her job” | Campaign for Reform At Southern Health

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