Recommendation 66

Stakeholder consultation as a pre-condition of foundation trust authorisation


The Department of Health, the NHS Trust Development Authority and Monitor should jointly review the stakeholder consultation process with a view to ensuring that:

  • local stakeholder and public opinion is sought on the fitness of a potential applicant NHS Trust for foundation trust status and in particular on whether a potential applicant is delivering a sustainable service compliant with fundamental standards
  • an accessible record of responses received is maintained;
  • the responses are made available for analysis on behalf of the Secretary of State, and, where an application is assessed by it, Monitor

The NHS Trust Development Authority will test trusts’ patient and public involvement strategies to ensure they are engaging with their patients and local community throughout the foundation trust application process, particularly on the quality of care being provided. It will also verify that trusts are explicitly asking questions about quality of care in their public consultation and triangulating responses with any identified issues of clinical quality.

The NHS Trust Development Authority will follow up with the trust on what it has done in response to any concerns raised during the consultation process and record this feedback, sharing the information with Monitor as necessary throughout the application process.

Monitor’s assessment process also includes reviews of patient views 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 their Quality Governance review they also seek to understand the trust board’s arrangements to actively engage with patients. Monitor will continue to consider the content of the consultation and the applicant’s response to the issues raised as part of the assessment process.


As set out in the NHS Trust Development Authority Accountability Framework for NHS Trusts, Trusts must demonstrate that they have sought feedback from the public regarding the quality of their services, and that this feedback is being used to make the necessary improvements.