Applying for foundation trust status is to become tougher as regulator Monitor responds to an expected rise in acquisitions and mergers and deters 'overly ambitious applications'.

In its business plan for 2007-08, the foundation trust regulator says it is planning to tighten up its assessment process and focus on establishing the management structure to operate the compliance regime and intervention framework for up to 200 NHS foundation trusts.

A spokesman from the organisation said: 'Monitor wishes to see the number of NHS foundation trusts increase as quickly as possible, without our standards being compromised.

Application capacity

'We have the capacity to assess 50 applications for NHS foundation trust status each year, including proposals for mergers and acquisitions. Therefore we are taking steps to look at how we can make the best use of these slots so the maximum number of trusts gain foundation trust status.

'This means looking at our processes for batching [ordering] of assessments and reviewing our deferral and postponement policies in light of this.

'We also plan to publish a document highlighting the issues behind postponements and deferrals, to help applicants be better prepared in the future.

Improving success rates

'The success rate on first application is currently under 70 per cent and if this could be improved to 90 per cent we could see as many as 144 NHS foundation trusts by 1 April 2009.'

Monitor's plan says that to use its resources most effectively, there must be a 'steady flow of high-quality applicant trusts' and that 'improving the authorisation rate will only be possible if Monitor can focus our assessment activity on the strongest applicants.'

To achieve this, Monitor plans to: refine its assessment processes to ensure efficient use of its limited assessment capacity; work with the Department of Health to identify what support Monitor can provide to ensure applicant trusts meet the required standards; and consider introducing a tighter time limit on deferrals and postponements to deter overly ambitious applications.

Long-standing weaknesses

The report says: 'It is possible that 2007-08 will see significant merger and acquisitions activity as the NHS seeks to reorganise provision to tackle long-standing financial weaknesses. The acquisition of Good Hope trust by the Heart of England foundation trust in April 2007 therefore may be the first of many such transactions.'

Acquisitions require Monitor to risk-rate the post-acquisition organisation, and mergers require a full, new authorisation. It is anticipated that this will have a knock-on effect on Monitor's capacity to carry out authorisations.

There are 65 foundation trusts at present and Monitor's business plan predicts there could be about 132 by 1 April 2009. This includes both acute trusts and mental health trusts.

The projection is based on Monitor's capacity to assess 50 applicants a year; an authorisation rate on first assessment of 70 per cent in line with experience to date; and a flow of applicant NHS trusts sufficient to enable it to make full use of its assessment capacity.

Monitor's vision for the year ahead

Monitor's business plan says that its focus in 2007-08 will be on:

  • establishing the management structure, systems, processes and people to operate the compliance regime and intervention framework for up to 200 foundation trusts;
  • ensuring that its assessment capacity is used effectively to make as much progress as possible towards an all-foundation trust model for the NHS;
  • working with partners to promote the development of NHS foundation trusts;
  • influencing the development of a devolved healthcare system;
  • increasing understanding of the role and contribution of NHS foundation trusts and Monitor in the health environment; and
  • building Monitor's internal capacity as a high-performing organisation.

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