We were established in January 2004 to authorise and regulate NHS foundation trusts. We are independent of central government and directly accountable to Parliament.
There are three main strands to our work:
You can find out more about Monitor's functions and powers, as detailed in the National Health Service Act 2006.
We receive and consider applications from NHS trusts seeking foundation status and look at three areas:
Is the trust well governed with the leadership in place to drive future strategy and improve patient care?
Is the trust financially viable with a sound business plan?
Is the trust legally constituted, with a membership that is representative of its local community?
If we are satisfied that certain criteria are met, we authorise the trust to operate as an NHS foundation trust.
Monitor’s role as regulator is to ensure that foundation trusts are well-led, that their leaders are focused on the quality of care patients get and that they are financially strong. When we look at the leadership of a foundation trust we look particularly at whether they are meeting the required quality standards, as judged by the Care Quality Commission, and at the trust’s financial strength. These two things are essential if they are to provide quality services for patients and value for money for taxpayers.
We regulate foundation trusts to ensure they comply with their terms of authorisation. These are a set of detailed requirements covering how foundation trusts must operate – in summary they include:
the general requirement to operate effectively, efficiently and economically;
requirements to meet healthcare targets and national standards; and
the requirement to cooperate with other NHS organisations.
The board is the first line of regulation in NHS foundation trusts. We ask each Board to submit an annual plan and regular reports to us. We then monitor how well the foundation trust is doing against these plans and identify where problems might arise.
Where problems start to develop we make sure the trust has an action plan in place and we monitor progress against the plan. Where possible we work closely with a trust to resolve a problem quickly.
We have powers to intervene in a foundation trust in the event of failings in its healthcare standards, or other aspects of its leadership, which result in a significant breach of its terms of authorisation.
Monitor supports the development of NHS foundation trusts ensuring they take full advantage of the freedoms and flexibilities that come with foundation trust status. Examples of our development programmes include:
Service-line management – an innovative approach to the management of NHS services that encourages clinical leadership, improved efficiency and better quality care;
Non-Executive Director Development Programme – to build leadership at board level;
Strategic Financial Leadership Programme - business school-based development programme for finance directors to support new ways of working in a fast changing NHS; and
NHS Foundation Trust Chairs' Academy - a unique programme specifically tailored to support chairs of NHS foundation trusts and aspirant foundation trusts in all aspects of leading their trusts through both current and future challenges.