Recommendation 71

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

The Secretary of State’s support for an application should not be given unless he is satisfied that the proposed applicant provides a service to patients which is, at the time of his consideration, safe, effective and compliant with all relevant standards, and that in his opinion it is reasonable to conclude that the proposed applicant will continue to be able to do so for the foreseeable future. In deciding whether he can be so satisfied, the Secretary of State should have regard to the required public consultation and should consult with the healthcare regulator.

The NHS Trust Development Authority’s role is to ensure, on behalf of the Secretary of State for Health, that aspirant foundation trusts are ready to proceed for assessment by Monitor. This role is discharged on behalf of the Secretary of State for Health by the board of the NHS Trust Development Authority, which will not refer to Monitor any trust where there are concerns relating to the compliance with any of the relevant standards either now or in the future. The decision of the board is made with regard to the public consultation and after consulting with the Care Quality Commission, NHS England and other national and local system partners.

No provider should be authorised as a foundation trusts unless the Care Quality Commission, through its Chief Inspector of Hospitals, judges that the quality of their services is ‘good’ or ‘outstanding’.


NHS Trusts are now required to produce 5-year strategic plans. Trusts will only have their Foundation Trust applications approved by the NHS Trust Development Authority Board if they are able to demonstrate their sustainability in the long-term, as well as achieving a ‘good’ or ‘outstanding’ rating.