Post application to Monitor, trusts are informed of the start date of their assessment. Each applicant is allocated an assessment team including a senior assessment manager. It is usual for the assessment team to spend a number of days visiting the trust during the assessment process to conduct interviews and analysis. This is in addition to careful scrutiny of information provided by the trust and third parties. We work particularly closely with the Care Quality Commission to ensure we have an up-to-date view of their position on applicant trusts.
Monitor's assessment process takes approximately four months from the start date, finishing in the authorisation of successful trusts. The number of applicants requiring time slots each month can vary with the number of referrals, and the existence of deferrals and postponements which require re-assessment. Applicants should therefore be aware that Monitor’s assessment phase may not commence immediately after referral to Monitor.
A list of applicants which have been passed to Monitor to be assessed is available on the current applicants page.
More information about what is required to demonstrate each of these criteria is available in the Guide for Applicants.
The CQC registers providers of care services if they meet essential standards of quality and safety and then monitors them to make sure they continue to meet these standards. All applicant trusts are required to demonstrate that:
- the impact of non-compliance on people who use the service is no worse than moderate impact
- the CQC is not conducting or about to conduct a responsive review into compliance; and
- no enforcement/investigation activity is on-going or planned including preliminary investigations into mortality outliers.
As part of the assessment process, each trust is given the opportunity to present its business plan to Monitor at a board-to-board meeting. This meeting is held midway through the assessment period.
The trust executive and non-executive board members will be expected to attend this meeting. Monitor will ask questions and provide challenge on the application. This meeting allows the applicant board to demonstrate that it is aware of the risks facing the trust and to provide details on how these risks can or have been managed and mitigated. The meeting also provides Monitor with a key opportunity to question the non-executive directors of the trust to determine whether they have the requisite skills to be able to challenge effectively the executive team.
Towards the end of the process Monitor’s assessment team will finalise papers to present at a decision meeting, where the application will be formally considered by Monitor. A decision may be made at this meeting to authorise, defer or reject a trust’s application. NHS trusts are also able to withdraw from the process or postpone their application until a later date under certain circumstances. Detailed information about the implications of these outcomes is available in the Guide for Applicants.
Monitor has been granted power under section 35 of the NHS Act 2006 to authorise applicant trusts. If the decision to authorise an applicant is made at Monitor decision meeting, the trust will be formally notified and issued with its terms of authorisation.
The terms of authorisation set out the conditions under which an NHS foundation trust is required to operate and cover such things as:
The terms of authorisation for all NHS foundation trusts are available on the NHS foundation trust directory.
Once NHS foundation trusts are established, we monitor their activities, as described in our Compliance Framework, to ensure that they comply with the requirements of their terms of authorisation. See how Monitor regulates for more information about our regulatory approach.
Monitor has discretion to defer an application where it feels outstanding issues are capable of being solved within a reasonable period of time. Monitor will expressly define and explain the matters requiring attention. Deferred trusts are not required to restart the NHS TDA foundation trust application process.
If an applicant is rejected, the trust will be formally notified. If the trust wishes at some future date to reapply for authorisation as an NHS foundation trust, it will have to restart the application process with NHS TDA.
Where issues arise during the assessment process which require resolution before an authorisation decision can be made, applicants may write to Monitor to request a period of postponement. Monitor considers the reasons put forward by the applicant on a case by case basis and the decision whether to accept a request for postponement is at Monitor’s discretion. Where a request for postponement has been accepted, the applicant trust will not need to regain NHS TDA support prior to having their application reconsidered by Monitor.
An application is treated as withdrawn if the applicant trust requests to be withdrawn from the process or if the trust does not reactivate its application in the timeframe set out in either the deferral letter or letter confirming a period of postponement.
A withdrawn application cannot be reactivated and continued at a future date. If an application is withdrawn and the applicant trust wishes at some future date to reapply for authorisation as an NHS foundation trust, it will have to regain NHS TDA support.
Once an NHS trust has been authorised as an NHS foundation trust, it will be regulated by Monitor to ensure it adheres to its terms of authorisation.
The terms of authorisation are a detailed set of requirements which describe how an NHS foundation trust must operate. For detailed information on how Monitor carries out its regulatory role, see How Monitor regulates NHS foundation trusts.
Each new foundation trust will receive a Welcome Pack from Monitor (we also send a separate Welcome Pack to governors of new foundation trusts) and will be assigned a Relationship Manager who is a senior member of the compliance team and who will be their main point of contact at Monitor.
There is a dedicated page on our website for each foundation trust within the foundation trust directory. These pages contain: the foundation trust’s contact details; risk ratings; terms of authorisation; the names of all the members of the council of governors and the board of directors; the latest annual report and accounts and annual plan; and, where applicable, a note to explain that the trust is in significant breach of its authorisation and/or details of any formal interventions.
How Monitor communicates with foundation trusts
Our relationship with each NHS foundation trust is primarily managed through contact with the trust’s board of directors. Each foundation trust is assigned a relationship manager who is a senior manager in Monitor’s compliance team. The relationship manager ensures a single point of contact is established to manage the flow of information between the foundation trust and Monitor.
We also send a monthly FT Bulletin to foundation trusts which highlights key updates, information and guidance. This is automatically sent to FT chairs, chief executives, and finance, medical and nursing directors. If you are not in any of these groups, you can subscribe to receive the bulletin.