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Monitor consults on Risk Assessment Framework

Monitor yesterday set out how it will judge whether NHS foundation trusts and other NHS-funded providers are at risk of failing to deliver key services for patients.

The health sector regulator is publishing for consultation a draft operational manual which it will use in future to monitor compliance by providers of NHS services with certain conditions of the new licence that Monitor will issue.

The principles behind the Risk Assessment Framework (RAF) are similar to those Monitor has used so far in regulating NHS foundation trusts, so do not represent any significant change to the current regulatory approach under Monitor’s compliance regime.

However, because Monitor’s new powers under the Health and Social Care Act 2012 will now cover additional matters and a wider range of providers of NHS services, the existing Compliance Framework is being replaced with a new regulatory tool, the RAF.

This will enable Monitor to make a more specific assessment of the risk of financial failure. The new monitoring regime will be introduced for NHS Foundation Trusts during 2013. A similar monitoring regime will also apply to any commercial or third sector providers from whom key NHS services are commissioned, when these are licensed from 2014.

The proposed new continuity of service risk rating will flag the risk of insolvency over the next 12-18 months on a scale of one to four, with the lowest rating signifying the highest level of concern.

The Risk Assessment Framework will also have additional measures to enable Monitor to continue to judge whether NHS foundation trusts are well-run, through strengthening the existing range of measures to assess good governance by taking extra material such as staff and patient satisfaction surveys into account.

NHS foundation trusts are public bodies, and these governance arrangements will not apply to private organisations providing NHS services, such as independent companies or charitable enterprises, as these already have their own governance arrangements.

Adrian Masters, Monitor’s Managing Director of Sector Development said:

"Parliament has made clear that hospital and community health services required by local NHS commissioners must be protected in the event of financial failure of a provider.

"This helps ensure continuity of key services for patients. In addition we have a continuing responsibility to ensure that NHS foundation trusts are well-run and able to supply the high quality services that patients need."

Notes to Editors

  • For media enquiries please contact Caroline Matlock, Media and Stakeholder Relations Manager on 0207 340 2535 (
  • Information about Monitor’s new role can be found here.
  • Monitor intends to run the new regime for NHS foundation trusts in parallel with the Compliance Framework for the first six months of 2013-14, before introducing the finalised Risk Assessment Framework. The RAF will only apply to independent sector and charity providers from whom key NHS services are commissioned, and only once these non-NHS organisations are required to be licensed, which is currently expected to be April 2014. The consultation on the Risk Assessment Framework runs from Thursday 10th January to Thursday 4th April. Further information and the consultation document can be found here.
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