On authorisation, each 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 foundation trusts must operate. They include:
Monitor’s Compliance Framework describes how we monitor foundation trusts compliance with their terms of authorisation.
Monitor requires each foundation trust board to submit an annual plan and quarterly and ad hoc reports. Performance is monitored against these plans to identify where potential and actual problems might arise. Monitor publishes quarterly and annual reports on these submissions and assigns each 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. We publish three 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.