Recommendation 67

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

The NHS Trust Development Authority should develop a rigorous process for the assessment as well as the support of potential applicants for Foundation Trust status. The assessment must include as a priority focus a review of the standard of service delivered to patients, and the sustainability of a service at the required standard.

The focus of the NHS Trust Development Authority is to enable NHS trusts to provide high quality, sustainable services for their local communities. It does this by overseeing all aspects of a trust board’s performance on delivering high quality care and supporting them to become sustainable organisations, thereby preparing them to become a foundation trust. The board of the NHS Trust Development Authority will only approve a trust’s application to be passed to Monitor, when it is satisfied that the trust has clearly demonstrated both these aspects.

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. There will be 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. No provider will go forward for foundation trust authorisation 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.