Strengthening the role of trust special administrators

The government has passed legislation reforming the statutory duties and responsibilities of trust special administrators (TSAs) appointed to providers of NHS-funded services in failure.  

We worked closely with members and other stakeholders to bring about and influence these reforms and will continue to do so as the changes are implemented. The information below sets out what we have done over the last two years. Find out all the details in Strengthening the role of TSAs: what you said, what we did.

Influencing on our members' behalf

We sit on the advisory committee which is reviewing the statutory guidance for TSAs, and are calling for it to be clear, realistic and meaningful. The next committee meeting is in December and we'd like to know whether there are any issues you'd like us to raise on your behalf. To share your thoughts, simply email

You can find out more about the committee, including its terms of reference by visiting the committee's website.

To strengthen our message we have recently submitted a joint response, with NHS Clinical Commissioners, to the stakeholder consultation on the statutory guidance for TSAs.

Influencing with impact

What you said

  • Short-term solutions to long-term financial problems are no longer sustainable.
  • Failure should only be seen as a last resort.
  • More needs to be done to support organisations in distress.
  • Turning around organisations requires a look at the whole system.
  • Rules of engagement for crisis-driven change need to be clearer.   

What we did

  • Ran a simulation event with members that tested new reforms for dealing with failure. 
  • Worked with representatives of doctors and patients to bring together views on reconfiguration and build evidence to influence the Government. 
  • Joined with stakeholders to call for reform to the failure regime and met together with the Care Bill team to give our views.
  • We submitted a joint response, with NHS Clinical Commissioners, to the stakeholder consultation.

What we called for on your behalf

  • Greater clarity on the rules of engagement with the local community.
  • A clearer sign from Monitor that meaningful public and other stakeholder involvement would be retained in the event of a crisis.
  • Changes to the failure regime, following concerns raised by members and the successful judicial review into the TSA proposals for South London Healthcare NHS trust.
  • Clarity on the legal authority for TSAs to make whole-system proposals.
  • For the Department of Health to consider the Care Bill – at that time being considered in Parliament – as vehicle to address several of our issues by putting forward Government amendments.                                  

What’s been achieved

  • Legislation has been passed that includes our recommendations and the changes we were calling for.
  • The TSA now has the legal authority to consider the whole system and not just the organisation in failure.
  • Timelines for the TSA have been extended to give it more time to produce and consult on recommendations for change.
  • Approval is now required from all commissioners affected by the TSA proposals and affected providers, patients and staff must be engaged.

What still needs to be done

  • We sit on a join a cross-party committee to advise the Department of Health on the guidance for TSAs appointed to NHS trusts.
  • We are calling for this guidance to be:
    • clear about what a TSA can and is expected to do
    • realistic about how a TSA should deal with disagreement
    • meaningful in bringing in local views and securing patient involvement.

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