Foundation trusts must accurately "self-certify" on all healthcare targets under a system which allows them to monitor their own performance or risk "significant financial and regulatory penalites", Monitor has warned.

In December the regulator decided to scrutinise 11 foundation trusts which had failed to hit performance targets they had claimed they would meet (news, page 6,20 December 2007).

After discovering that the trusts had failed to live up to their claims, Monitor asked each trust to commission urgent independent reviews of their self-certification process.

In a report published this week on the findings from the reviews Monitor found limited evidence that effective forecasting and analysis of historical performance is being used to inform boards' discussions.

The report also said the 11 foundation trusts had a "lack of understanding of how action plans will deliver the reductions necessary to meet the target".

It also highlighted that self-certifications were "diverging" from foundation trusts' risk registers. This means that although boards had declared anticipated compliance with their terms of authorisation to meet the targets, they had then also rated their organisation as high risk on risk registers for individual targets.

The regulator has warned foundation trusts that a failure by boards to understand actual and potential performance and take action may not only impact on patient care but is also "expensive and reputationally damaging".