Recommendation 62

Patient and public involvement in Monitor

For as long as it retains responsibility for the regulation of FTs, Monitor should incorporate greater patient and public involvement into its own structures, to ensure this focus is always at the forefront of this work.

A central theme of Monitor’s Quality Governance Framework is whether the boards of NHS organisations actively engage patients, staff and other key stakeholders on quality. From April 2013 it is also a licence condition that foundation trusts actively engage with patients on the quality of care and take into account their views. Monitor’s assessment process includes reviews of patient surveys and the NHS staff survey, meetings with staff and patient groups, review of access and outcome metrics, local media coverage and interviews with lead commissioners, the Care Quality Commission and external and internal auditors. Monitor also writes to local MPs and Healthwatch to see if they have any concerns they wish to raise.  As part of Monitor’s qualitygGovernance review they seek to understand the trust board’s arrangements to actively engage with patients. Levels of service performance and standards of care quality form part of Monitor’s regular risk assessment of foundation trusts including the Care Quality Commission’s judgements on the quality of care provided. Monitor also expects licence holders to notify them in the event of any incident, event or report that may raise potential concerns over compliance with the licence. Regulatory action may also be triggered by information from local patient groups if it represents a material concern. This is underpinned by two-way sharing of information on patient complaints by Monitor and Care Quality Commission and sharing of intelligence on the quality of care by regional and local quality surveillance groups. Where enforcement action is required further intelligence may be sought including seeking the views of patient representatives and undertaking further analysis of the complaints made to the foundation trust, Monitor and Care Quality Commission.

To further embed patient involvement in Monitor’s processes, Monitor is currently engaging with the Department of Health on the recruitment of a Medical Advisor and Director of Patient and Clinical Engagement, and has developed three patient engagement work strands which will be taken forward over the next 12 months. Projects are underway working with a social research consultancy, patient representative bodies, Healthwatch and other national level health organisations, to help Monitor better understand what good practice looks like when engaging and consulting with patients, the public and their representatives.

Monitor has also pledged to build the use of patient intelligence and complaints into their regulatory approach, working closely with the Care Quality Commission, and will put in place a plan to ensure that ‘patients first’ is embedded into its culture and ways of working.


Monitor appointed Hugo Mascie-Taylor as Medical Director and Director of Patient and Clinical Engagement in May 2014. A good practice toolkit to guide Monitor’s patient engagement has also been developed and a patient awareness programme undertaken including an all staff event on making a difference for patients. ‘Patients first’ is now one of Monitor’s five values and further work is planned to embed the values into Monitor’s everyday work.