Provider regulation

Since April 2016, Monitor and the NHS Trust Development Authority operate jointly under a single leadership to undertake a number of regulatory functions in relation to NHS providers and to offer a range of tailored improvement support.

NHS Improvement

In law, NHS foundation trusts and trusts are overseen by two organisations: Monitor and the NHS Trust Development Authority (TDA). Monitor issues foundation trusts with a provider licence which acts as the main statutory instrument through which it regulates. The NHS TDA monitors NHS trusts through its oversight framework. As of April 2016, in response to the similar challenges facing all NHS providers, Monitor and the NHS TDA now act as a single body which also encompasses some additional functions previously exercised by other statutory organisations*.

Quote mark NHS Improvement is responsible for overseeing NHS foundation trusts, NHS trusts and independent providers. We offer the support these providers need to give patients consistently safe, high quality, compassionate care within local health systems that are financially sustainable. By holding providers to account and, where necessary, intervening, we help the NHS to meet its short-term challenges and secure its future. NHS Improvement

Foundation trusts and NHS trusts alike are now regulated through the Single Oversight Framework, which assesses performance against five themes:

Providers are required to provide information to NHS Improvement on a regular basis, including annual submissions of strategic and operational plans, monthly submissions of financial and performance information, exception reports (i.e. a Royal College report that identifies concerns relevant to the trust’s governance of quality) and periodic governance reviews. Providers are segmented according to any concerns that NHS Improvement identifies in relation to the above themes, and this determines the level of oversight, intervention and mandatory or voluntary support they receive.

NHS Improvement also operates as a sector regulator to exercise Monitor's statutory responsibilities relating to setting prices for NHS funded care in partnership with NHS England, enabling integrated care, safeguarding patient choice and preventing anti-competitive behaviour.


*NHS Improvement is the operational name for the organisation that brings together Monitor, NHS Trust Development Authority, Patient Safety, the National Reporting and Learning System, the Advancing Change team and the Intensive Support Teams.

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