How we do it

Under the Health and Social Care Act (2012), Monitor has an ongoing role in assessing NHS trusts for foundation trust status, and ensuring that, once licensed, foundation trusts are well-led, in terms of both quality and finances.

We will also license other providers of NHS services from April 2014. We do this in a number of ways and work closely with other health care organisations in order to carry out our role.

We also support commissioners to ensure that services continue to be available to patients, in the rare event of the failure of a health care provider.

How we assess NHS trusts

We carry out a robust and challenging process to assess trusts applying for NHS foundation trust status. We examine governance arrangements, financial viability, local accountability and performance against national standards and targets.

The Act states that all NHS trusts will be required to become foundation trusts (or become part of a foundation trust) as soon as clinically feasible, with a clear target of April 2014.

We welcome this commitment and remain committed to seeing all trusts capable of becoming foundation trusts come forward to Monitor for assessment, and will be working with the NHS Trust Development Authority (NHS TDA) and the Department of Health to help achieve this. However, our main priority is to ensure that our assessment standards remain consistent throughout the drive to ensure all eligible trusts reach foundation trust status.

You can read more about our assessment process here.

How we regulate NHS foundation trusts

Monitor has issued all foundation trusts with a licence and this will be the main tool by which we regulate them. We will license all other eligible NHS providers from April 2014. The licence incorporates a set of conditions covering financial viability and governance as well as other areas reflecting Monitor’s expanded role within the health sector. 

We assess a breach or a potential breach of the governance and continuity of service licence conditions through a, risk-based system of regulation which determines the intensity of the monitoring we undertake at each foundation trust. We identify actual and potential financial and governance problems, and deal with them effectively. See the How Monitor regulates NHS foundation trusts section for more information.

How we develop NHS foundation trusts

Monitor is committed to ensuring the development of NHS foundation trusts. We have developed service-line management to help foundation trusts manage clinical areas as distinct operational units. We also run courses for senior NHS staff.

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