External reviews for Foundation Trusts to tackle rise in governance problems

Monitor has called for ‘robust’ external reviews on Foundation Trusts every three years to tackle the rise in governance problems.

Monitor has published proposals that would see Foundation Trusts (FT) undertaking external reviews every three years in response to a rising rate of governance problems across the system.

Since 2008, 25% of FTs have faced regulatory action, usually due to poor governance. Most problems arise two years after the establishment of the FT, lending weight to Monitor’s call for triennial reviews.

The “robust” external reviews can be conducted by an independent reviewer, said Monitor, unless FTs have amber-red or red ratings, in which case the review would be undertaken by Monitor themselves. Monitor hope the implementation of regular reviews will bring down the number of FTs facing regulatory action and allow areas of improvement to be highlighted on a regular basis.

Toby Lambert, director of strategy and policy at Monitor, said “Good governance enables trusts to meet the challenges they face, while providing patients with the high quality care they deserve.”

“We believe regular effective governance reviews are a vital tool in showing that a trust is well-led, and whether any of their practices or capabilities need to improve.”

Under the new proposals, which are now in consultation, these reviews must be “robust, in-depth and tailored to cover the specific circumstances of the board”.

They should also be carried out by independent reviewers to ensure “objectivity and provide maximum assurance”.

Chris Hopson, chief executive of the Foundation Trust network, welcomed the move to “formalise good practice that has already been adopted across a significant proportion of the..sector”. He did, however, raise concerns that such ‘formalisation’ could create a “’tick box’ exercise that provides work for consultancies, but gives little value to those that use the NHS.” 

As part of the consultation process for Monitor’s proposals, three FTs will pilot the new approach: Newcastle upon Tyne Hospitals, Airedale and the Lincolnshire Partnership.