Assessing governance risk in NHS foundation trusts
We use the term governance to describe the effectiveness of an NHS foundation trust's leadership.
We use performance measures such as whether foundation trusts are meeting national targets and standards, e.g. a reduction in MRSA rates, as an indication of this, together with a range of other governance measures described below. We consider these areas when assessing governance risk at foundation trusts, as reflected in the risk ratings which we publish for each trust:
- Legality of constitution – NHS foundation trust constitutions are legal documents that describe how each is governed. You can find more information in Monitor's Model Core Constitution;
- Growing a representative membership – NHS foundation trusts are accountable to their local communities and must have plans in place to develop and grow a representative membership;
- Appropriate board roles and structures - Monitor checks whether the appropriate roles exist and are filled within each NHS foundation trust. We also look for evidence that a collaborative but challenging relationship exists between the board of governors and the board of directors, and the executive and non-executive members of the board of directors;
- Cooperation with NHS bodies and local authorities – NHS foundation trusts have a duty as part of their terms of authorisation to cooperate with a range of NHS bodies and with local authorities;
- Clinical quality – a board must be satisfied, and certify to Monitor, that their NHS foundation trust has effective measures and arrangements in place to monitor and continually improve the quality of healthcare it provides;
- Service performance (healthcare targets and standards) – boards have to confirm to us that plans are in place to ensure that priority targets and standards will be met continually;
- Other risk management processes – boards must address and resolve any risks that have been identified. If issues are outstanding, the board must demonstrate to Monitor that robust plans are in place to address them; and
- Provision of mandatory services - boards have to confirm that they expect to be able to continue to provide mandatory services which are listed in schedules 2 and 3 of their terms of authorisation (the conditions under which they must operate).
