Once licensed, each NHS foundation trust is assigned a Monitor relationship manager (details can be found in the foundation trust directory). The relationship manager ensures that where an NHS foundation trust is in breach of its licence, the trust's board takes the appropriate remedial action.
The licence has a number of conditions, and Monitor will use a number of methods to assess licensees’ compliance with them. Monitor's current Compliance Framework describes in detail how we monitor each NHS foundation trust's compliance with:
Our current Compliance Framework describes in detail how we monitor each foundation trust's compliance with its licence, it also references our Quality Governance Framework which measures the structures and processes in place to ensure effective, trust-wide, oversight & management of quality performance. The current Compliance Framework will be replaced by the Risk Assessment Framework from October 2013.
Where the Compliance Framework indicates that the foundation trusts are breaching or potentially breaching, their Continuity of Service or governance conditions, we will consider whether formal investigation is required in order to assess the scale and scope of the breach and what, if any, regulatory action is appropriate. Details of this process and Monitor's enforcement powers are here.
Monitor requires each NHS foundation trust board to submit an annual plan and quarterly and ad hoc reports. These are used to assess risk on a forward-looking basis and to hold boards of foundation trusts to account.
Monitor publishes sector summaries based on these submissions, on a quarterly and annual basis, and assigns each NHS foundation trust with an annual and quarterly risk rating. These risk ratings are designed to indicate the risk of a failure to comply with the Continuity of Services and governance licence conditions. Monitor can adjust risk ratings to reflect the escalation process set out in the Compliance Framework.
We publish two risk ratings for each NHS foundation trust, on:
Based on these risk ratings, the intensity of monitoring and the potential need for regulatory action is considered on a case-by-case basis. This also applies where a foundation trust is performing well, for example moving from the usual quarterly monitoring to six-monthly monitoring.
When Monitor identifies a risk of an NHS foundation trust breaching its licence we may seek further information and/or open a formal investigation. The issues we find are likely to drive our regulatory response – for instance we may seek an agreed recovery plan to return the trust to compliance. However, if the need for action is time-critical, Monitor’s Board will consider using its formal powers to intervene. More information can be found in Regulatory action.
In addition, Monitor works closely with a number of organisations, including the Care Quality Commission (CQC), in order to carry out its role. CQC is responsible for safeguarding appropriate standards of quality and safety within adult health and social care in England. See how we are working together with our partners, for patients.