On authorisation, 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 fails to comply with its terms of authorisation, the trust’s board takes the appropriate remedial action.
The terms of authorisation are a set of detailed requirements covering how NHS foundation trusts must operate. They include:
Monitor’s Compliance Framework describes in detail how we monitor each NHS foundation trust's compliance with their terms of authorisation, it also references our Quality Governance Framework which measures the structures and processes in place to ensure trust-wide quality performance.
Monitor requires each NHS foundation trust board to submit an annual plan and quarterly and ad hoc reports. Performance is monitored against these to identify where potential and actual problems might arise. 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 terms of authorisation. 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 a foundation trust is at risk of breaching its terms of authorisation Monitor requires them to explain why and it is likely we will require an action plan from the board. If this plan fails to demonstrate improvement in an acceptable time period, 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. For more information see our Working in partnership section.