Date published: 26 August, 2025
Date last updated: 26 August, 2025
Integrated care

Assessing provider capability: guidance for NHS trust boards

Introduction

As part of the NHS Oversight Framework (NOF), NHS England will assess NHS trusts’* capability, using this alongside providers’ NOF segments to judge what actions or support are appropriate at each trust. As a key element of this, NHS boards will be asked to assess their organisation’s capability against a range of expectations across 6 areas derived from The insightful provider board, namely:

  • strategy, leadership and planning
  • quality of care
  • people and culture
  • access and delivery of services
  • productivity and value for money
  • financial performance and oversight

These will inform a self-assessment which is intended to strengthen board assurance and help oversight teams take a view of NHS trust capability based on boards’ awareness of the challenges their organisations face and subsequent actions to address them. The purpose of this is to focus trust boards’ attention on a set of key expectations related to their core functions as well as encourage an open culture of ‘no surprises’ between trusts and oversight teams. NHS England regional teams will then use the assessment and evidence behind it, along with other information, to derive a view of the organisation’s capability.

This document is designed to help boards make this self-assessment, set out the process and what organisations can expect along the way.

* NHS trust is used throughout this document to refer both to NHS trusts and NHS foundation trusts. The expectations set out in the document apply equally to both types of organisation.

The self-assessment

This process set out here should not be seen as a ‘tick box’ exercise. As outlined above, the purpose is to promote self-awareness and transparency at NHS trust boards regarding their organisation’s capabilities, strengths, weaknesses and the challenges they face. It also provides a consistent framework for regional oversight teams to engage with NHS trusts, identify key risks and, over time, assess management’s track record in delivering performance and/or identifying and addressing issues to ensure strong, sustainable organisations able to deal with challenges as they emerge. Trusts will have 8 weeks to carry out this self-assessment and return it to regions.

Where boards already conduct effectiveness reviews, they should consider the degree to which these overlap with this self-assessment. In addition, and to avoid duplication, relevant evidence gathered to support NHS trusts’ annual governance statements can also support the self-assessment.  

Summary of the capability assessment cycle

Figure.1: the capability assessment process

Accessible text: 

Figure 1 above sets out the self-assessment process which will take a number of stages across the year:

1. NHS trust boards carry out an annual self-assessment against the 6 domains in The insightful provider board and:

  • highlight any areas for which they consider they do not meet the criteria, the reasons why and the actions being taken or planned then, within 2 months
  • submit the completed self-assessment template to their regional oversight team with supporting evidence

2. Oversight teams review the self-assessment and:

  • triangulate this with other information including the trust’s recent operational history and track record of delivery and third-party intelligence (see below) as necessary to develop a holistic view of capability
  • assign a capability rating to the trust

Oversight teams will discuss the capability rating with the NHS trust and consider, in the round, the principal challenges the organisation faces, prioritising issues and the actions needed – for example, monitor something more closely, request follow-up action(s) and/or refresh the capability rating to reflect concerns if necessary.

3. Oversight teams will, across the financial year, use the capability assessment to inform oversight, for example where:

  • risks flagged in the self-assessment are a concern (for example, inability to make 1 or more certifications), or
  • annual self-assessments do not tally with oversight team’s views or information from third parties, or
  • subsequent performance/events at the trust or third-party information are a cause for concern such that elements of the self-assessment are no longer valid and, in order to assess ‘grip’, teams may wish trusts to review the basis on which they made the initial assessment.

The self-assessment

Below we provide indicative examples of the evidence boards should use or lines of enquiry they might consider taking to assess whether they can positively self-certify against each criterion. These should not be seen as exhaustive, and we expect trusts will have developed specific approaches to gain assurance in particular areas.

I. Strategy, leadership and planning

Self-assessment criteria

Indicative evidence or lines of enquiry

1. The trust’s strategy reflects clear priorities for itself as well as shared objectives with system partners.
  • Are the trust’s financial plans linked to and consistent with those of its commissioning integrated care board (ICB) or ICBs, in particular regarding capital expenditure?
  • Are the trust’s digital plans linked to and consistent with those of local and national partners as necessary?
  • Do plans reflect and leverage the trust’s distinct strengths and position in its local healthcare economy?
  • Are plans for transformation aligned to wider system strategy and responsive to key strategic priorities agreed at system level?

2. The trust is meeting and will continue to meet any requirements placed on it by ongoing enforcement action from NHS England.

 
  • Is the trust currently complying with the conditions of its licence?
  • Is the trust meeting requirements placed on it by regulatory instruments – for example, discretionary requirements and statutory undertakings – or is it co-operating with the requirements of the national Performance Improvement Programme (PIP)?

3. The board has the skills, capacity and experience to lead the organisation.
  • Are all board positions filled and, if not, are there plans in place to address vacancies?
  • What proportion of board members are in interim/acting roles?
  • Is an appropriate board succession plan in place?
  • Are there clear accountabilities and responsibilities for all areas of operations including quality, delivering access standards, operational planning and finance?

4. The trust is working effectively and collaboratively with its system partners and NHS trust collaborative for the overall good of the system(s) and population served.
  • Is the trust contributing to and benefiting from its NHS trust collaborative?
  • Does the board regularly meet system partners, and does it consider there is an open and transparent review of challenges across the system?
  • Can the board evidence that it is making a positive impact on the wider system, not just the organisation itself – for example, in terms of sharing resources and supporting wider service reconfiguration and shifts to community care where appropriate and agreed?

II. Quality of care

Self-assessment criteria

Indicative evidence or lines of enquiry

5. Having had regard to relevant NHS England guidance (supported by Care Quality Commission information, its own information on patient safety incidents, patterns of complaints and any further metrics it chooses to adopt), the trust has, and will keep in place, effective arrangements for the purpose of monitoring and continually improving the quality of healthcare provided to its patients.
  • The trust can demonstrate and assure itself that internal procedures:
    • ensure required standards are achieved (internal and external)
    • investigate and develop strategies to address substandard performance
    • plan and manage continuous improvement
    • identify, share and ensure delivery of best practice
    • identify and manage risks to quality of care
  • There is board-level engagement on improving quality of care across the organisation.
  • Board considers both quantitative and qualitative information, and directors regularly visit points of care to get views of staff and patients.
  • Board assesses whether resources are being channelled effectively to provide care and whether packages of care can be better provided in the community.
  • Board looks at learning and insight from quality issues elsewhere in the NHS and can in good faith assure that its trust’s internal governance arrangements are robust.
  • Board is satisfied that current staff training and appraisals regarding patient safety and quality foster a culture of continuous improvement.

6. Systems are in place to monitor patient experience and there are clear paths to relay safety concerns to the board.
  • Does the board triangulate qualitative and quantitative information, including comparative benchmarks, to assure itself that it has a comprehensive picture of patient experience?
  • Does the board consider variation in experience for those with protected characteristics and patterns of actual and expected access from the trust’s communities?
  • Is the board satisfied that it receives timely information on quality that is focused on the right matters?
  • Does the board consider volume and patterns of patient feedback, such as the Friends and Family Test or other real-time measures, and explore whether staff effectively respond to this?
  • How does the organisation involve service users in quality assessment and improvement and how is this reflected in governance?
  • Is the board satisfied it is equipped with the right skills and experience to oversee all elements of quality and address any concerns?
  • Is the board satisfied that the trust has a clear system to both receive complaints from patients and escalate serious and/or re-occurring complaints to the relevant executive decision-makers?

III. People and culture 

Self-assessment criteria

Indicative evidence or lines of enquiry

7. Staff feedback is used to improve the quality of care provided by the trust.
  • Does the board look at the diversity of its staff and staff experience survey data across different teams (including trainees) to identify where there is scope for improvement?
  • Does the board engage with staff forums to continually consider how care can be improved?
  • Can the board evidence action taken in response to staff feedback?

8. Staff have the relevant skills and capacity to undertake their roles, with training and development programmes in place at all levels.
  • Does the trust regularly review skills at all levels across the organisation?
  • Does the board see and, if necessary, act on levels of compliance with mandatory training?

9. Staff can express concerns in an open and constructive environment.
  • Does the board engage effectively with information received via Freedom To Speak Up (FTSU) channels, using it to improve quality of care and staff experience?
  • Are all complaints treated as serious and do complex complaints receive senior oversight and attention, including executive level intervention when required?
  • Is there a clear and streamlined FTSU process for staff and are FTSU concerns visibly addressed, providing assurance to any others with similar concerns?
  • Is there a safe reporting culture throughout the organisation? How does the board know?
  • Is the trust an outlier on staff surveys across peers?

IV. Access and delivery of services

Self-assessment criteria

Indicative evidence or lines of enquiry

10. Plans are in place to improve performance against the relevant access and waiting times standards.
  • Is the trust meeting those national standards in the NHS planning guidance that are relevant to it? If not, is the trust taking all possible steps towards meeting them, involving system partners as necessary?
  • Where waiting time standards are not being met or will not be met in the financial year, is the board aware of the factors behind this?
    Is there a plan to deliver improvement?

11. The trust can identify and address inequalities in access/waiting times to NHS services across its patients.
  • The board can track and minimise any unwarranted variations in access to and delivery of services across the trust’s patients/population and plans to address variation are in place.

12. Appropriate population health targets have been agreed with the integrated care board.
  • Is there a clear link between specific population health measures and the internal operations of the trust?
  • Do teams across the trust understand how their work is improving the wider health and wellbeing of people across the system?

V. Productivity and value for money

Self-assessment criteria

Indicative evidence or lines of enquiry

13. Plans are in place to deliver productivity improvements as referenced in the NHS Model Health System guidance, the Insightful board and other guidance as relevant.
  • Board uses all available and relevant benchmarking data, as updated from time to time by NHS England, to:
    • review its performance against peers
    • identify and understand any unwarranted variations
    • put programmes in place to reduce unwarranted negative variation.
  • The trust’s track record of delivery of planned productivity rates.

VI. Financial performance and oversight

Self-assessment criteria

Indicative evidence or lines of enquiry

14. The trust has a robust financial governance framework and appropriate contract management arrangements.
  • Trust has a work programme of sufficient breadth and depth for internal audit in relation to financial systems and processes, and to ensure the reliability of performance data.
  • Have there been any contract disputes over the past 12 months and, if so, have these been addressed?
  • [Potentially more appropriate for acute trusts] Are the trust’s staffing and financial systems aligned and show a consistent story regarding operational costs and activity carried out? Has the trust had to rely on more agency/bank staff than planned?

15. Financial risk is managed effectively and financial considerations (for example, efficiency programmes) do not adversely affect patient care and outcomes.
  • Does the board stress-test the impact of financial efficiency plans on resources available to underpin quality of care?
  • Are there sufficient safeguards in place to monitor the impact of financial efficiency plans on, for example, quality of care, access and staff wellbeing?
  • Does the board track performance against planned surplus/deficit and where performance is lagging it understands the underlying drivers?

16. The trust engages with its system partners on the optimal use of NHS resources and supports the overall system in delivering its planned financial outturn.
  • Is the board contributing to system-wide discussions on allocation of resources?
  • Does the trust’s financial plan align with those of its partner organisations and the joint forward plan for the system?
  • Would system partners agree the trust is doing all it can to balance its local/organisational priorities with system priorities for the overall benefit of the wider population and the local NHS?

Inability to make a positive self-assessment

The board may not be able to make a positive self-assessment either because it considers the risks in a specific area are too great or its organisation is already manifestly failing in a specific area (for example, delivering on access targets). In these situations – and in line with the ‘no surprises’ ethos – in the self-assessment template boards should provide:

  • the reasons why a positive self-assessment cannot be made against specific criteria and the extent to which these have been outside the trust’s control to address (for example, industrial action, system-wide factors)
  • how long the reasons have persisted
  • a summary of any mitigating actions the trust has taken or is taking
  • if not already shared with oversight teams, a high-level description of trust plans to address the issue, how long this is likely to take and KPIs or other information the trust will use to assess progress

Oversight teams will use this information to form their view of the overall capability of the trust and tailor their oversight relationship with it.

Material in-year changes

In addition to the annual self-assessment, if the board becomes aware in-year of a significant change to its ability to meet any of the self-assessment criteria – for example, an external report reveals material quality risks or an unforeseen cost will affect its financial performance – it should inform the oversight team along with the actions it is taking to address the issue. Such in-year changes will likely inform the ongoing regulatory relationship with the NHS England region.

The NHS provider trust capability rating

Regional oversight teams will review the trust’s submitted self-assessment and consider the statements and evidence. Using a range of considerations, including the historical track record of the trust, its recent regulatory history and any relevant third-party information, the oversight team will decide the trust’s capability rating and share this with it, including the rationale for the rating.

Rating: Green

  • High confidence in management.

Indicative criteria

  • No concerns evident from the self-assessment or subsequent performance.
  • No concerns arising from third-party information.
  • High confidence in the trust’s ability to deliver on its priorities based on track record over past 12–24 months.

Rating: Amber–green

  • Some concerns or areas that need addressing.

Indicative criteria

  • After discussion with the trust, some concerns emerging across more than 1 domain, but these as yet are not affecting quality of care, delivery of core services, finance or the wider reputation of the NHS.
  • Trust has prepared plan(s) to address any problems with associated timeframe for delivery.
  • Historical issues/track record mean NHS England does not (yet) have full confidence in the board.

Rating: Amber–red

  • Material issue needs addressing or failure to address major issues over time.

Indicative criteria

  • Issues with self-assessment or subsequent issues across multiple domains.
  • Failure to deliver on agreed plans to address a material issue.
  • Potentially in breach of licence.

Rating: Red

  • Significant concerns arising from poor delivery, governance and other issues.

Indicative criteria

  • Material or long-running concerns at the organisation that management has been unable to grip.
  • NHS trust in breach of licence or likely to be.

Third-party information

As set out in the NHS Oversight Framework, third-party information relating to the organisation’s governance and risk profile, staff morale and quality of care provided may inform NHS England’s view of NHS trust capability. We expect that where trusts receive information that impacts on their self-assessment they should share this with NHS England. Relevant third parties include:

  • other bodies with regulatory responsibilities, where concerns can reflect weaknesses in internal governance and systems of internal control and oversight – including the Information Commissioner, Human Tissue Agency and NHS Blood and Transplant
  • professional representative bodies, reflecting issues with working conditions, staff morale, operating culture and safety – including the General Medical Council, Nursing and Midwifery Council and Royal Colleges
  • patients and the public, reflecting issues in areas such as patient experience and culture via groups like Healthwatch
  • staff information, reflecting issues in internal culture and inability to speak up, for example via staff survey or whistleblowers
  • integrated care board partners, covering areas like the trust’s willingness to collaborate and deliver shared goals
  • other NHS England teams, reflecting knowledge from central programmes like quality, cyber assurance or digital maturity
  • relevant oversight groups, including joint strategic oversight groups (JSOG) and system and regional quality groups
  • other sources as relevant to the NHS trust, including coroners, Parliamentary Health Service Ombudsman, local government and Social Care Ombudsman, Ofsted, the trust’s internal and external auditors and even the police

For further information on relevant information from third parties please see annex 1. 

Annex 1: Bodies with relevant information on NHS trust capability

NHS England

Responsibilities

  • Uses the conditions in the NHS trust licence it issues to NHS foundation trusts (and which also applies to NHS trusts in shadow form) to regulate trusts across a range of areas, including delivery of services, quality governance and efficiency, economy and effectiveness of management.
  • Oversees the training of healthcare staff. Trusts liaise with it on matters like resident doctor training and NHS England has the power to remove resident doctors from trusts if conditions are unsatisfactory.
  • Operates a cyber assurance service to build cyber security across the NHS, assessing alignment to key standards relating to the cyber assessment framework and indicators of good practice.

Considerations/areas to look at for NHS trust capability

  • Meeting national standards.
  • Compliance with the NHS trust licence.
  • Resident doctor survey.
  • Delivering NHS objectives.
  • Collaborating with NHS trusts.
  • Cybersecurity.

Care Quality Commission

Responsibilities

  • Registers organisations to provide care in England, sets regulations covering the care trusts provide, runs an inspection and monitoring regime and publishes NHS trust ratings.

With NHS England:

  • Provides joint strategic leadership and alignment for quality through the National Quality Board (NQB).
  • As co-signatories of the NQB guidance for system quality management, work together as part of a culture of open and honest co-operation to identify opportunities for improvement, early warning signs, concerns and risks, and take collaborative action, working with systems to mitigate and manage quality.
  • Ensures coherent oversight arrangements are in place for systems, integrated care boards (ICBs) and NHS trusts to ensure services are safe and effective.
  • Shares learning and information about quality risks/concerns in a timely and proactive way, through system quality groups, regional quality groups and wider discussions, and respecting regulatory frameworks.

Considerations/areas to look at for NHS trust capability

  • Quality of care – are any sites or services operated by the NHS trust classed as ‘inadequate’?
  • Governance and culture – are there concerns for NHS England arising from the CQC’s well-led review across the whole organisation?

Medicines and Healthcare products Regulatory Agency

Responsibilities

  • Regulates medicines, medical devices and blood transfusion components.

Considerations/areas to look at for NHS trust capability

  • Systems in place to ensure proper and safe use of medical equipment.

Human Tissue Authority

Responsibilities

  • Regulates the removal, storage, use and disposal of human bodies, organs and tissue.

Considerations/areas to look at for NHS trust capability

  • Systems in place to safely and legally handle human tissue.

The Human Fertilisation and Embryology Authority

Responsibilities

  • Regulates and inspects all clinics in the UK providing in vitro fertilisation (IVF), artificial insemination and the storage of human eggs/sperm/embryos – this may include some trusts.

Considerations/areas to look at for NHS trust capability

  • Systems in place to meet standards associated with IVF and related procedures.

The Health and Safety Executive

Responsibilities

  • Has a national remit over matters like workplace safety, estates conditions which covers trusts.

Considerations/areas to look at for NHS trust capability

  • Systems in place to ensure staff, patients and the public work in a safe environment.

The Information Commissioner’s Office

Responsibilities

  • Has a national role to uphold information rights in the public interest May be in contact with trusts regarding patient confidentiality, for example setting data requirements.

Considerations/areas to look at for NHS trust capability

  • Systems in place to manage data securely and in compliance with all relevant standards.

NHS Counter Fraud Authority

Responsibilities

  • Investigates reports of fraud, bribery and corruption across the NHS.

Considerations/areas to look at for NHS trust capability

  • Systems and culture in place to ensure zero tolerance of fraud, bribery and corruption at the NHS trust.

Professional regulators

  • General Medical Council
  • Nursing and Midwifery Council
  • General Chiropractic Council
  • General Dental Council
  • General Optical Council
  • General Osteopathic Council
  • General Pharmaceutical Council
  • Health and Care Professionals Council
  • Social Work England

Responsibilities

  • Together with NHS England, ensure proper standards of practice in respective professions to protect, promote and maintain the health and safety of the public.
  • Most have responsibilities across the UK and all regulate professionals regardless of whether they work in the NHS or the independent sector.
  • As a designated body, NHS England has a statutory duty under the responsible officer regulations for GPs on the national performers list and for responsible officers from designated bodies across a wide variety of sector organisations.
  • NHS England must inform professional regulators where professionals fail to meet the standards. This can lead to an investigation and potentially sanctions such as conditions on practice, suspension or removal from a professional register.
  • Responsible for quality assuring the education and training of healthcare professionals. Most can inspect organisations that commission, oversee or provide education, and they have powers to withdraw approval from training programmes, posts or NHS trusts if they are not satisfied that education or training is being provided in a safe or effective way. In April 2023, NHS England took on the previous powers of Health Education England to regulate training NHS trusts and placement hosts.

Considerations/areas to look at for NHS trust capability

  • Staff can work in and contribute to a safe, sustainable environment that ensures good morale and a healthy working culture that supports high quality care.

Local government and Social Care Ombudsman
Parliamentary and Health Service Ombudsman

Responsibilities

  • Provide an independent complaint handling service.

Considerations/areas to look at for NHS trust capability

  • Evidence of patient or staff concerns at health and care NHS trusts.

Health Service Safety Investigations Body

Responsibilities

  • Investigates serious patient safety risks that span the healthcare system, operating independently of other regulatory agencies.

Considerations/areas to look at for NHS trust capability

  • Quality assurance arrangements at NHS trusts.

Healthwatch

Responsibilities

  • Shares learning and information through system quality groups, regional quality groups and the NQB to ensure that the views and experience of people and the public informs quality improvement and risk management discussions.
  • Note: The Dash Review recommends abolishing Healthwatch. If followed through, this will need to go through a number of steps before being enacted in legislation, likely in late 2026/early 2027. Until then, Healthwatch will continue to gather patient views and evidence and work together with NHS trusts and commissioners to improve local services.

Considerations/areas to look at for NHS trust capability

  • The NHS trust uses patient and public information in reviewing the care provided at the organisation.
  • Is there any evidence of patient concerns that might indicate issues with the provision and oversight of care provided?

Ofsted

Responsibilities

  • Investigates education settings, including secure children’s homes and SEND services.

Considerations/areas to look at for NHS trust capability

  • Is there any evidence of patient concerns that might indicate issues with the provision and oversight of care provided at specific sites managed by the NHS trust?

Coroners

Responsibilities

  • Coroners investigate deaths that are unnatural or violent or where the cause is unknown or that took place in prison, police custody or another type of state detention, such as a mental health hospital.

Considerations/areas to look at for NHS trust capability

  • Is there any evidence of concerns or issues – for example, organisational culture or governance – that may have led to a death at the institution?

Royal Colleges

Responsibilities

  • The professional bodies that oversee and regulate various medical specialties. These colleges set standards for training, examinations, and continuing professional development for doctors in their respective fields. They also play a role in policy and advisory work related to their specialties.

Considerations/areas to look at for NHS trust capability

  • Do information from Royal Colleges – for example, anonymised data from surveys of their members – highlight cultural, quality of care or patient safety concerns at the trust?  

Local authorities

Responsibilities

  • Along with other roles, local authorities help develop the population health needs assessment. Trusts are expected to work with system partners to meet these needs.

Considerations/areas to look at for NHS trust capability

  • Is there any evidence that the trust is not an effective system partner across its geography?

Publication reference: PRN01888_i

 

 

Date published: 26 August, 2025
Date last updated: 26 August, 2025