Friday; I woke up in bed with David Bennett, boss of Off-Sick and the highest paid person in the NHS (�230k). Perhaps I should start again; On Friday morning I was in bed and David Bennett was on the wireless. The alarm decided to start my day at the precise moment he was on the Today Programme droning on about the kicking Margaret Hodge, Chair of the PAC, had given Monitor.

It's no way to start the day, is it? Life is miserable enough without the permanent shadow of nimbus-nigrum Monitor casts over everything. To be honest, he didn't have too much of a problem; soft quizzed by Evan Davis who sounded like the leader of the Monitor fan-club.

First, does he hire too many consultants; he does it to iron out the seasonal peaks in workflow. Second, he was under compliment in staffing, why; key tasks were covered and recruiting now to cover recently acquired extra responsibilities. Third, for a health regulator he had few clinicians; he said clinicians weren't his job (that was the CQC) and he consulted when he needed to.

I was reaching for the off button when he was asked how come over a quarter of FTs, 39 out of 147, were predicting a year end deficit when he is supposed to be regulating them.  I shouted at the radio; 'what does Bennett do all day for �230k?'  They weren't listening. 

Bennett said (in terms) Trusts are facing a tricky time; his role is to step in when things go wrong. If you look at his brief there's not much more he can do. The interview became a bit of an ear-worm for me and I've cogitated on it ever since.

From the evidence of my in-box I think it is fair to say Monitor has few friends; they are seen as arrogant, abstract and removed.  

A week or two ago, at a railway station, I happened upon a group of familiar faces. A Trust Chief Executive and his top team were on their way to a meeting with Monitor. Six rail fares, six top people way from their desks, six people on their way down to London to do something that at best could have been done on a conference-call, Skype or Face Time and at worse Monitor could have got off their backside and gone to the Trust. Institutional arrogance says; 'I'm the Regulator, you come to me'.

Only 7 of Monitor's 337 staff have a clinical background and only 21 have experience of running or working in the NHS so perhaps they would have had trouble finding someone who knows what a hospital looks like? For the record; they are usually a big building with a tall chimney and can be found at the end of a traffic jam next to a no smoking banner.

I guess it all boils down to the question; is Monitor doing a good job?   Tricky, you have to define a good job! In their terms they are comfy and cosy, only occasionally are they challenged and generally merge into the cluttered landscape of the NHS.

Better question; do they add value? Much easier to answer... no. For instance; three trusts have been in breach of their regulatory conditions since 2009. Monitor can't seem to sort out, fast enough, why Trusts are in trouble. Local health economies overheat very quickly and that is usually a problem emanating from commissioners, Monitor don't see it coming.  Stressed Trust leadership can crumble and Monitor does not have trusted, close, partnership relationships, to spot it and deal with it.

I seems to me Monitor is clever but not smart, omnipotent but not influential, big movers but not nimble, ever-present but not there. They are consultant-wise but not street-wise, they are Billy-no-Mates when FTs need friends. Monitor is slow, ponderous, dull, uninspiring and grey. Instead of bringing life to their work they seems to me to suck the life and energy from the people they are there to help.

They try to drive down tariff prices but are responsible for Trust viability. They're pushing services into community settings, disrupting Trusts' viability.  They try to prevent anti-competitive behaviour but know merger and less choice is the inevitability of driving down prices.  They are hopelessly conflicted and exist in a fog.  It is not entirely a fog of their own making, they have a confusing brief and have become the repository for everything no one else wants to do.   

Is Monitor value for money? You decide; Monitor spends almost one-third of its budget on central services with 30 people employed to work on 'strategic communications'. Nearly 30 of their staff are paid over �100,000 a year and they don't have a permanent chairman.

I think this is an organisation that was built for another purpose, to generate competition.  The mess of the H&SCAct sort of put paid to that.  Now they say their job is to 'make the health sector work better for patients'.  I see no evidence of that.  How are they making it work better?   

Monitor has lost its way and is definitely not worth getting out of bed for.