NHS trusts: apply for NHS foundation trust status

Apply for NHS foundation trust status and learn about the assessment process and possible outcomes of your application.

Monitor assesses NHS trusts before they can become NHS foundation trusts to ensure they are well led so they can deliver good quality care for patients on a sustainable basis.

This guide provides an overview of the NHS foundation trust assessment process. It takes account of changes to the process introduced since an updated Guide for applicants was published in October 2013.

Before Monitor’s assessment

As an NHS trust, you’ll need to work with the NHS Trust Development Authority (NHS TDA) to get ready for the NHS foundation trust assessment process.

The NHS TDA will help to develop and prepare your NHS trust for the assessment process, alongside its routine oversight.

The Care Quality Commission’s (CQC) Chief Inspector of Hospitals will then conduct a thorough inspection of your trust. Before you can be granted foundation trust status, Monitor needs the CQC’s assurance that the quality and safety of the services your trust provides meet the required quality threshold. Under the CQC’s new ratings system, your NHS trust will need an overall rating of ‘good’ or ‘outstanding’ to pass to the next stage of the assessment process.

After your CQC inspection, if the NHS TDA board is satisfied that your trust is ready to proceed, then the TDA will offer its support for your application to be passed to Monitor.

Please note, if your trust was already with Monitor for assessment when the CQC’s new inspection regime was introduced, you will have your CQC inspection during the Monitor phase of the assessment and will not need to go back to the NHS TDA for approval.

Start your assessment

Once Monitor receives confirmation that you have the NHS TDA’s support, we’ll write to you to ask for:

  • a covering letter from your chief executive
  • a copy of the letter confirming you have the support of the NHS TDA
  • your proposed constitution
  • your integrated business plan as submitted to the NHS TDA

Once you have submitted this information, Monitor will write to confirm when your assessment will happen. For details of how Monitor prioritises applications, see the Guide for Applicants.

Assessment criteria

During your assessment, Monitor will:

  • test whether your trust meets the required quality performance threshold (working closely with the Care Quality Commission to determine this)
  • assess how well run your trust is
  • assess the financial viability of your trust to ensure it can continue to deliver high quality care on a sustainable basis

Assessment process

The assessment process generally takes around 4 months to complete.

During the assessment process, you’ll need to submit a range of documents and information to Monitor. The Guide for Applicants gives details on the information you’ll need to supply.

Monitor’s assessment team will also spend a number of days visiting your trust to conduct interviews and analysis. Monitor will also meet other local organisations, such as commissioners and local Healthwatch organisations.

Once most of the assessment work has been completed, you’ll have the opportunity to present your trust’s business plan to Monitor. Your trust’s executive and non-executive board members will be expected to attend this meeting and answer questions put to them by Monitor. This meeting allows your board to demonstrate that it is aware of the risks facing the trust and to provide details on how these can or have been managed and mitigated. It also gives Monitor the opportunity to question your non-executive directors to find out if they have the skills they need to challenge the executive team effectively.

Possible outcomes

Towards the end of the process, Monitor’s assessment team will make a decision on your application. We may authorise, defer or reject it.

Being authorised

If you are authorised as an NHS foundation trust, you’ll be notified by Monitor and issued with an NHS provider licence.

Being deferred

Monitor can defer your application if there are outstanding issues that it believes your trust can solve within a reasonable period of time. If this happens, Monitor will explain the matters needing attention. Deferred trusts are not required to restart the application process with the NHS TDA.

Being rejected

If your application is rejected, Monitor will notify you of this. If you later want to reapply to become an NHS foundation trust, you will have to restart the application process with the NHS TDA.

Postpone or withdraw your application

You may withdraw from the assessment process or postpone your application until a later date under certain circumstances. Detailed information is available in the Guide for Applicants.


If issues arise during the assessment process that your trust must resolve before Monitor can make a decision, you may write to us to ask for a period of postponement. Monitor considers these requests on a case-by-case basis. If we accept your request, you will not need to regain NHS TDA support before restarting the assessment process.


If you ask to be withdrawn from the assessment process, or if you do not reactivate your application in the timeframe set out in a deferral letter or letter confirming a period of postponement, Monitor will stop the assessment process.

In this case, if you later wish to reapply for authorisation as an NHS foundation trust, you will need to regain NHS TDA support.

Current applicants

The following NHS trusts have received approval from the NHS Trust Development Authority to apply for NHS foundation trust status:

If you have any information about any of the NHS trusts in the list above that you wish Monitor to consider, please email

The Guide for applicants

Applying for NHS foundation trust status: guide for applicants (October 2013) (PDF, 1.05MB, 110 pages)

Update on applying for FT status (November 2013) (PDF, 265KB, 3 pages)

Update on applying for FT status (September 2013) (PDF, 104KB, 2 pages)

Model core constitution

The NHS provider licence

Well-led framework for governance reviews