Recommendation 65

Quality of care as a pre-condition of foundation trust authorisation

Accepted
The NHS Trust Development Authority should develop a clear policy requiring proof of fitness for purpose in delivering the appropriate quality of care as a pre-condition to consideration for support for a Foundation Trust application.

The NHS Trust Development Authority has published its accountability framework which sets out how trusts will be held to account for delivering the appropriate quality of care. Trusts which are failing to meet these standards are subject to a robust and transparent escalation process.

The first priority for all provider organisations and for the bodies that oversee them should be to secure high quality services for patients. NHS trusts are only able to progress through the foundation trust pipeline if they have been consistently delivering high quality care, as assessed against the standards in the accountability framework, which include concerns raised by the Care Quality Commission and others, such as commissioners.

The board of the NHS Trust Development Authority will not support applications to progress to Monitor where there are any doubts about the quality of the services being provided by a trust. In order to ensure this, future inspections of the quality of services provided by aspirant foundation trusts and their quality governance processes will take place earlier in the application process, prior to the NHS Trust Development Authority board making its decision as to whether an application should be supported. No provider will be put forwards for authorisation as a foundation trust unless the Care Quality Commission, through its Chief Inspector of Hospitals, judges that the quality of their services is ‘good’ or ‘outstanding’.

Update

Since the decision was made only to support Foundation Trust applications from providers with a Care Quality Commission rating of ‘good’ or ‘outstanding’, the NHS Trust Development Authority has advised the Care Quality Commission on trusts that should be considered as priorities for inspection in order to allow their Foundation Trust bids to progress. 55 NHS Trusts have been inspected under the new arrangements, and of these ten have received NHS Trust Development Authority board approval to be considered by Monitor for Foundation Trust authorisation.