Recommendation 69

Quality and sustainability as a pre-condition of foundation trust authorisation

The assessment criteria for authorisation should include a requirement that applicants demonstrate their ability to consistently meet fundamental patient safety and quality standards at the same time as complying with the financial and corporate governance requirements of a Foundation Trust.

The NHS Trust Development Authority has set out its rigorous process for assessing aspirant foundation trusts in its accountability framework Delivering High Quality Care For All. Quality and sustainability are the focus of the foundation trust application approvals process. This involves a comprehensive inspection by the Care Quality Commission of the quality of services delivered by an aspirant foundation trust, as well as the quality governance arrangements within a trust, prior to any decision by the Board of the NHS Trust Development Authority as to whether a foundation trust application will be supported.

Trusts are challenged throughout Monitor’s assessment process to demonstrate that they meet all of the assessment criteria relating to quality and safety. A number of changes in relation to providing evidence of quality have already been implemented to strengthen this (see recommendations 62 and 66 for details), and in particular NHS trusts who aspire to become foundation trusts will in future no longer be able to do so unless and until they have achieved a ‘good’ or an ‘outstanding’ rating under the new Care Quality Commission inspection regime.

A joint working group between Monitor, the Care Quality Commission and NHS Trust Development Authority has been formed to ensure that the process for assessing applicant trusts reflects the recommendations of the inquiry. This work is intended to strengthen further the assessment of quality in the approvals process through better sharing of information and expertise, alignment of metrics and ensuring more consistent judgements on quality.


The ‘end to end’ review of the authorisation process is now complete and changes have been made to how quality is assessed in the process e.g. early quality governance review, NHS Trust Development Authority de-briefing meeting at the beginning of assessment and a revised threshold for referral to Monitor linked to the Care Quality Commission’s rating.