The NHS Trust Development Authority today releases its “accountability framework” setting out how it will work with the NHS trusts that have not yet achieved foundation status.
The authority said it marked a shift from the past system, in which trusts were accountable to their strategic health authority and the Department of Health for their progress along the “foundation trust pipeline”.
The document sets out the new processes for FT application assessments, performance measurement, the support organisations can expect and the “escalation” process for trusts that have fallen behind.
The TDA has stressed that the system should not be more onerous for trusts and the processes will be more standardised than they have been in the past.
The £27m arms-length body combines the powers of several predecessor organisations, including powers of appointment from the Appointments Commission, capital funding approval and foundation trust application oversight.
Quality assessments will be performed monthly, with measures taken from the NHS mandate, DH access figures, patient experience scores plus CQC assessments, “third party reports” and “monthly indicators of staff satisfaction”.
Quarterly quality assessments will look at “compliance with choice and competition licence terms” and “staff survey results” and “board observations”, the framework said.
These will all feed into five overall measures: CQC concerns, access, outcomes, third-party reports and quality governance.
Each of these five will be rated one to five from “no identified concerns” through “concern requiring investigation” to “formal action required”.
The financial measures will be “bottom-line income and expenditure position”, an assessment of savings programmes, including the proportion of recurrent and non-recurrent savings, and a “forecast underlying revenue position compared to plan for the year”.
The Department of Health already uses an “escalation process” for trusts that are significantly behind on their plans. The TDA will also use this term.
The accountability framework said the four regional directors of delivery will have a monthly meeting with trusts, “the tone of [which] will be respectful, constructive and focussed on outcomes not processes”.
The directors will look at the data, make an assessment of the organisation’s ability to turn around, and use “‘soft’ intelligence based on routine interactions with the trust and partner organisations”.
The TDA will also operate an “effective but proportionate appraisal process” annually for non-executive directors and chairs.
The authority also outlined the annual planning process, with a final operating plan submitted at the start of each financial year.
The first drafts for 2013-14 were submitted on January 26 and the final versions are due to be signed off today.
The TDA will develop a clinical faculty “to provide access to expert advice on specific clinical issues”, the framework said.