Consultation outcome

Consultation on changes to the risk assessment framework: June 2015

This consultation has concluded

Detail of outcome

Detail of feedback received

We issued a consultation on changes to the risk assessment framework in June 2015. We received over 80 responses and we have taken these into account when finalising the updates to the risk assessment framework published in August 2015.

Thank you to everyone who took the time to respond to the consultation.

Original consultation

This consultation ran from to


Monitor is proposing changes so we can help foundation trusts meet the continuing and significant challenge facing the NHS.


Consultation on changes to the risk assessment framework: June 2015

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Consultation description

The risk assessment changes outlined in this document apply to foundation trusts only.

The NHS faces a continuing and significant challenge to simultaneously improve quality, meet access targets and drive up productivity. Meeting this challenge means there can be no let-up in the pace and scale of change in provider organisations.

Given this challenging context we are proposing a number of measures to strengthen our regulatory regime so that we can help foundation trusts live within their means and support improvements in financial efficiency across the sector.

These measures include proposed changes to:

  • the risk assessment framework
  • the NHS foundation trust accounting officer memorandum described in this consultation document

We are proposing these changes to enable us to take regulatory action earlier if a foundation trust is in deficit, failing to deliver its financial plan, or not providing value for money.

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Next steps: August 2015

The risk assessment framework has been updated in response to the consultation in June 2015. These changes are in addition to those made in March 2015 and include:

  • monitoring in year financial performance (income and expenditure margin) and the accuracy of planning
  • combining a foundation trust’s rating on these 2 measures with the existing elements of the CoS risk rating to produce a new single financial sustainability risk rating
  • including a value for money governance measure within the existing governance rating
  • the requirement for all foundation trusts to submit monthly financial information as highlighted in the recent FT bulletin

The changes we have made will enable us to act sooner where there are concerns about a foundation trust’s financial sustainability and/or efficiency. However they will not lead to an automatic licence breach. They allow us to consider whether a potential investigation is necessary.

We have also made changes to the accounting officer memorandum to strengthen the requirement to consider value for money.