How the assessment process works

This section provides an overview of the NHS foundation trust assessment process.

Monitor’s approach to regulation is one of risk management. Monitor must be confident and able to provide assurance to Parliament and a wide range of stakeholders that NHS foundation trusts will be legally constituted, financially sustainable, well-governed and locally representative. These are essential requirements for NHS foundation trusts to be able to operate with sufficient freedoms, to deliver national health priorities and to respond to local needs.

Rigorous assessment will ensure that NHS foundation trusts are financially sustainable with strong management, minimising the need for intervention.

Before trusts can be authorised as NHS foundation trusts, they move through three distinct phases of activity during the application and assessment process:

  1. Strategic Health Authority (SHA)-led Trust Development Phase – to prepare NHS trusts for the application process and Secretary of State support;
  2. Secretary of State Support Phase – to determine whether applicant NHS trusts are eligible to apply to Monitor for assessment; and
  3. Monitor Phase – to assess and potentially authorise Secretary of State for Health supported NHS trusts as NHS foundation trusts.

Monitor’s involvement in the process starts at phase three, once an NHS trust has received approval from the Secretary of State to apply for NHS foundation trust status.

This diagram gives an overview of the NHS foundation trust assessment process (PDF), including approximate timescales.

A rigorous assessment process is the cornerstone to Monitor’s Compliance Framework, which ensures a risk-based proportionate approach to regulation post authorisation. For more information about our approach to regulation see how Monitor regulates NHS foundation trusts.