Assessing provider capability – guidance for boards

This briefing sets out NHS Providers’ views on and analysis of Assessing provider capability – guidance for NHS trust boards, published today by NHS England (NHSE). It includes a summary of the key content and an overview of our work to influence the guidance on your behalf.

Please note that ‘NHS trust’ is used throughout the guidance to refer to both NHS trusts and foundation trusts.

The NHS oversight framework 2025/26 (NOF) set out how NHSE would use provider capability assessments to determine their improvement response, enabling them to understand how capable an organisation is of improving without additional support.

The focus on provider boards’ awareness of the challenges facing their organisations, and what is needed to address them, is intended to promote board self-awareness as well as transparency with oversight teams, providing a framework for their engagement with providers.

The capability self-assessment guidance confirms that boards will self-assess annually against the six oversight domains set out in The insightful provider board. 

NHSE notes potential overlap with aspects of boards’ existing effectiveness reviews, and evidence used for the annual governance statement (AGS) in annual reporting can be reused for this exercise where relevant.

The self-assessment should be submitted to their regional NHSE oversight team along with supporting evidence, for example the board paper(s) used to agree the self-assessment. The self-assessment should highlight any areas of concern, the reasons why, and planned or taken actions to address.

The timescales for this during 2025 are for boards to do the self-assessment within eight weeks of when they receive the guidance. They should then submit the required declaration form to the regional team, which then has four weeks to review and triangulate with information from a variety of other sources, before coming to a view about a capability rating. These will be discussed with provider boards, and trusts allocated to the Provider Improvement Programme (PIP) will be told in December.

The six domains are set out, alongside self-assessment criteria and non-exhaustive examples of indicative evidence that the board might require to assure itself of compliance. Trusts are expected to use their own approaches to gain assurance in each of the areas.

The domains are:

• Strategy, leadership and planning
• Quality of care
• People and culture
• Access and delivery of services
• Productivity and value for money
• Financial performance and oversight

The Excel template for certification requires boards to highlight any areas where they do not meet the criteria, explain why, and set out remedial action underway or to be taken.

Ongoing interaction with the oversight team across the financial year will enable conversations about areas of concern, areas where NHSE may have contradictory information from other parties, or new concerns have arisen and the initial assessment may need to be reviewed. If the trust is aware of a significant in-year change it should notify the oversight team immediately. The aim is to adopt a ‘no surprises’ approach.

NHSE will triangulate the board self-assessment with third party information to determine which of four capability ratings to allocate: green, green-amber, amber-red, or red. Green denotes high confidence in management. Amber-red and red ratings indicate possible and likely breaches of the provider licence, respectively.

Third parties whose input may be considered include Care Quality Commission (overall rating  and specifically well-led); integrated care board(s); trust staff, patients and the public; coroners; professional regulators; and local authorities. An annex sets out these possible third parties and the type of information they may provide.

Drawing on our Good quality regulation report, our influencing has consistently highlighted members’ view that oversight across the NHS must follow the principles of ‘right-touch’: it should be proportionate, consistent, targeted, transparent, and agile, and regulators should be able to justify their decisions and be publicly accountable for them. 

We have sought to influence and improve the numerous drafts of oversight guidance from NHSE over the past few years, submitting formal consultation responses in June 2024 and June 2025, based on feedback from convened meetings with trust leaders and members’ responses to our regulation and oversight survey 2024.

In June 2025, we highlighted how the published NOF 2025/26 differed from previous versions, noting our disappointment that the capability assessment methodology was not published at the same time. We also said we hoped NHSE would consult on this guidance before publication. While there was no formal consultation, we have been grateful for several meetings with NHSE to discuss the likely methodology and share members’ views. 

We successfully made a strong case that self-assessments should be annual rather than quarterly, since little fundamentally changes regarding board capability over three months, and this frequency risked the process either becoming a tick-box exercise, or taking up too much valuable board time. We then focused our attention on making the regulatory process as useful as possible for trust boards, to ultimately benefit their patients by helping them become stronger organisations.

We argued successfully for neutral language, grounded in improvement rather than naming and shaming, in relation to capability ratings, and queried whether oversight segmentation was capable of being appropriately objective if provider capability (a fundamentally subjective judgement) was amalgamated into the final segment score. This has since been removed from the NOF segmentation methodology. 

We argued that any provider capability assessment should keep the onus on boards to understand their own capability and the capacity of their organisations, reflecting the principle of subsidiarity and respecting the self-governing autonomy of NHS boards. In our detailed feedback on specific self-certification statements, we noted that it would be important not to cut across existing board mechanisms for undertaking annual board effectiveness reviews, and that it would be helpful to articulate any read across to Care Quality Commission well-led assessments. 

We also highlighted how both the NOF and proposed capability guidance needed to be framed appropriately for use in trusts with shared leadership or group model arrangements. This was not reflected in the final publication and it will be important to monitor how this works in practice.

We are grateful to NHSE for their ongoing engagement. 

In summary: 

• The proposed self-assessment process has the potential to support boards’ self-awareness and enhance their levels of assurance.
• The level of risk being carried throughout the trust sector at the moment creates the possibility that, for many trusts, it will not be possible to say they are fully compliant across all domains.
• Care will need to be taken to ensure this does not duplicate existing internal and external assurance processes.  
• Whether the ratings process and the relationship with oversight teams adds value will depend on how the ongoing relationships between regulator and trusts are conducted, and the values that underpin these interactions.  

It is good practice for boards to undertake regular reviews of their levels of assurance, and this self-assessment approach enables them to do just that. 

We welcomed the flexible approach detailed in The insightful provider board, as well as its inclusion of governance advice that would be helpful for newer board members wanting to understand their role and responsibilities as part of a unitary board. Drawing on this to inform the self-assessment process is logical, provides consistency, and should be helpful to boards. 

The level of risk being carried throughout the trust sector at the moment creates the possibility that for many trusts, it will not be possible to say they are fully compliant across all domains. This is because the compliance response in each domain is limited to three options: “confirmed”, “partially confirmed”, or “not met”, with a broad set of criteria needing to be met in each domain.

Given this, it would have been helpful to have guidance on the factors in each domain that would necessitate trusts reporting “partially confirmed”.

There is a risk that most providers will need to report that they are partially compliant in the majority of domains, as there is always likely to be room for improvement or risks that cannot be fully mitigated. This may lead to an unhelpfully inaccurate picture of leadership capability across the provider sector.

Where trusts are broadly well run but not fully able to mitigate all risks facing them, it will be important that regional teams take a sophisticated approach as they judge overall capability. 

Many boards will already have well-established processes in place to annually assess their effectiveness (encompassing culture, effectiveness of meetings/paperwork and the secretariat, and the softer but vitally important board skills and behaviours in evidence). It is helpful that this capability self-assessment in part overlaps with this type of review, and also overlaps with elements of the AGS required as part of annual reporting. To avoid minimising duplication and unnecessary burden, it will be important that boards are able to combine these assurance exercises to ensure their time is best used to improve its levels of assurance.

There is no methodology set out here for how NHSE will triangulate the self-assessment with other sources of information, nor precisely how it will arrive at a final rating – a process that is likely to involve some degree of subjective judgement. In this context, the relationship between the oversight teams in the regions and provider boards will be essential in awarding a fair and accurate capability rating. Mutually respectful and transparent relationships will be needed for NHSE to form a robust view of the trust board’s effectiveness. Where this is the case, a relationship with a regulator may be value adding for boards, and so for the taxpayer and patients, if it is able to focus on improvement and support rather than punishment or naming and shaming.

It will be important for NHSE to approach oversight conversations in the round, without over-emphasising narrow financial or operational performance (something our members have consistently raised with us). The focus of oversight conversations drives organisational focus and behaviours: this new oversight approach is a chance to break the cycle and approach the relationships aiming to support, empower, and recognise effective leadership.

There are a few specific concerns:

• Consistency across the regions will be important but is likely to be hard to achieve. 
• The wording of one of the financial criteria, asking boards to confirm ‘financial considerations do not adversely affect patient care’ may be challenging for boards to fully endorse. Without infinite resource, it is inevitable that choices must be made, and those choices will have consequences. It would have been preferable to have framed this as ensuring relevant impact assessments are done and patients engaged where necessary, to make difficult funding decisions.
• The reporting template is in an Excel format, requiring typed responses, which will be unwieldy and increase administrative burden.
• The direction of travel regarding reporting centrally is one that governance leads in particular may note. NHSE removed declarations against the provider licence (G5) and the corporate governance statement from annual reporting in 2023. This was done to place the emphasis back on boards to conduct their own assurance, and to reduce duplication against other reporting requirements.

We are keen to continue to work with our members and NHSE to provide feedback on this process as it is undertaken this year, and seek improvements if necessary. We are particularly interested in the level of burden this process creates for trusts, and whether they are able to give an accurate impression of how well run they are with the criteria given. Please contact izzy.allen@nhsproviders.org with any feedback on the guidance or its implementation.