Foundation trust regulator Monitor should “make allowances” for aspirant community foundation trusts and consider adjusting its assessment framework accordingly, according to the author of a confidential review the sector’s future commissioned by the Department of Health.

The report by Dr Vineta Bhalla, obtained by HSJ, delivers a positive assessment of the 17 aspirant CFTs’ efforts to date, but concludes that “it is going to be difficult for an assessment or review to predict the long term viability of a particular trust; no matter how high the bar of requirements is set.”

Dr Bhalla, a director of hospital services in Singapore and currently a research fellow at Imperial College London, suggested the foundation trust process for the community sector should be a “learning journey with a strong component of continued support and development.”

Speaking to HSJ, she said “traditional” ways of assessing a would-be FT would not work for community trusts.

“The FT framework has forced [community trusts] to look at themselves and there is a lot more awareness of what they need to do,” she added.

“But Monitor needs to make some allowances to understand them. It may have to adjust its framework accordingly.

“We are waiting to see if Monitor has that understanding. Foundation trust status shouldn’t be a success or fail test. It’s not helpful to anyone if we do that.”

There have been concerns aspirant community trusts will struggle to achieve FT status, because of their vulnerability to large-scale contract changes and their asset-light nature, which makes it difficult for them to meet Monitor’s financial requirements.

Dr Bhalla’s report says community trusts have “evolved significantly” with “clear plans for development of strategic partnerships and tailoring of services to meet with and compete for commissioners’ requirements.”

But she also warned that the FT process could create “assessment fatigue” among smaller executive teams.

While some community trusts were well prepared for the FT process others were “overwhelmed” by it, she said.

A spokesman for Monitor said it was satisfied with its process for assessing community trusts adding: “All organisations seeking foundation trust status have to meet the requirements for authorisation as set out in our Guide for Applicants framework. Prior to starting our assessment of community trusts we reviewed our process to ensure that it was fit for purpose for these trusts.

“The process is designed to ensure that if authorised, a trust can meet our regulatory expectations of providing patients with good quality care on a sustainable basis by a well-led organisation.”