Ward of court: Kate Moore, Monitor

It is unusual to find an in-house legal adviser who is so supremely conscious of the needs of the end user. But then again, for Kate Moore, who heads up the in-house legal team at NHS foundation trust watchdog Monitor, the end users are sick patients in hospital wards up and down the country.

“The public service element of my job is its continuing pull: knowing that my advice can impact directly upon patients and the quality of care they receive is a major incentive,” explains Moore.

Foundation trusts were part of New Labour’s ‘modernisation’ of the NHS, introduced in 2004 to devolve decision-making from central government control to local organisations and communities.

Under the changes, hospitals can become independent legal entities and have unique governance arrangements. They are accountable to local people, who can also become members and governors. As they are no longer performance managed by health authorities, Monitor has to make sure the foundation trusts are being run efficiently and are maintaining a good standard of patient care.

“NHS foundation trusts must be legally constituted, financially viable and well-governed. Monitor is independent of central government and directly accountable to Parliament,” explains Moore.

But she admits that foundation trusts wobble from time to time. The case of the Mid-Staffordshire NHS foundation trust, which has recently been plastered across the national media after a series of deaths, is a case in point.

The Healthcare Commission published a highly critical report into the hospital, which identified many failings including serious understaffing, lack of training and multiple management failures. The investigation was triggered by high mortality rates at the trust since April 2005.

“The failings at Mid-Staffordshire attracted major Parliamentary and media attention, necessitating central legal input ranging from advice to the board on use of intervention powers, Freedom of Information Act requests, stakeholder handling, review of press notices and generally acting as devil’s advocate and risk manager, in true in-house lawyer fashion,” recounts Moore.

Moore, who heads a team of five, has powers of intervention when a trust’s healthcare standards start to slip or aspects of its leadership fail, breaching its terms of authorisation.

“The legal department is essential to Monitor’s operations: we’re a statutory regulator and must be legally compliant in all we do,” she explains. “When I joined Monitor, the legislation was pretty much virgin territory, which was an exciting challenge. I insisted that I report directly to the executive chairman Bill Moyes and was part of the senior management team. In this way I can help shape policy and Monitor’s approach.”

And with a trim external legal spend of only £40,000 a year, Moore and her team are kept busy dealing with every aspect of the organisation’s legal needs, including HR and corporate matters as well as advising on formal interventions.

“A lot of our powers are discretionary: I think framework rather than prescriptive legislation is appropriate since it enables us to be flexible and adapt to a huge variety of healthcare scenarios,” she argues.

Just after taking on her new role as head of legal at Monitor in 2004, Moore had to use her powers of intervention at Bradford Teaching Hospital’s NHS foundation trust. This flagship trust slid into financial difficulty, causing it to breach its terms of authorisation and led to Monitor sacking the trust’s chairman.

“If a trust is failing we have sweeping statutory powers to intervene,” says Moore. “Our first such intervention was at Bradford, where we removed the chair of the board of directors from his post in late 2004. It proved to be a true turning point for the trust.”

There are 120 NHS foundation trusts, 36 of which are mental health trusts. With the Government planning to authorise more across the country, Moore and her team will no doubt have their hands full.

“Monitor has always had a healthy respect for legal advice and understands that the secure management of legal risk is crucial,” she points out.

Reflecting on her own principles over the foundation trust model, Moore insists you do not have to be a “zealot” to head up the Monitor legal team, but a belief that foundation trusts mean better patient care is essential.

Name: Kate Moore
Title: Director of legal services
Organisation: Monitor
Industry: Healthcare regulation
Reporting to: Executive chairman Bill Moyes
Number of employees: 97
Legal capacity: Five
Main external law firms: Denton Wilde Sapte, Osborne Clarke
Annual legal spend: £40,000

Education:

1984: MA, Downing College, Cambridge
1985: College of Law, Guildford

Work history:
1987-90: Assistant solicitor, Slaughter and May
1990-92: Senior solicitor, Wilde Sapte
1992-98: Head of legal, Investors Compensation Scheme
1998-2004: Principal consultant, regulatory services department, KPMG
2004-present: Director of legal services, Monitor