NHS England and NHS Improvement use our ratings to help decide if NHS trusts need extra support.
Trusts have access to extra support when there are issues to do with finance or quality of care. This support is part of the NHS System Oversight Framework 2021/22. The framework explains how NHS England and NHS Improvement work with NHS organisations in England.
There are 2 levels of support, depending on how serious or complex the issues are.
- Mandated support
This is provided by the NHS England and NHS Improvement regional teams. Under some circumstances, the regional teams may also access support from the national intensive support team. If you need this level of support, you will enter segment 3 of the NHS System Oversight Framework. - Mandated intensive support
This is provided by the national intensive support team through the national Recovery Support Programme. If you need this level of support, you will enter segment 4 of the NHS System Oversight Framework.
The Recovery Support Programme has replaced Special Measures for NHS trusts.
How our ratings influence mandated support and mandated intensive support
Our ratings are one of the possible criteria for trusts entering mandated support and mandated intensive support. The NHS Oversight Framework sets out other criteria and factors.
Mandated support
If we give a rating of requires improvement overall and for our well-led key question, NHS England and NHS Improvement will decide if you need mandated support.
If you do, the NHS England and NHS Improvement regional team will work with you and us to agree exit criteria. These are the criteria you would need to meet before the support can end.
The team will continue to support you until you're ready to meet the exit criteria and you can demonstrate sustained improvement.
Mandated national intensive support
How you enter the programme
If we give a rating of inadequate for well-led and for at least one other key question, we make a recommendation that you enter mandated intensive support.
The final decision over whether you need mandated intensive support is made by NHS England and NHS Improvement.
Mandated Intensive support is delivered through the national Recovery Support Programme. The programme provides support either at organisational level or across an Integrated Care System (ICS). This level of support includes the appointment of an improvement director. The improvement director will coordinate support and help you develop an improvement plan. The improvement plan will include an indicative timescale for meeting the exit criteria. This is typically within 12 months.
Our role
We will stay in close contact with you, NHS England and NHS Improvement during the process. We will also continue to monitor quality. We normally carry out a follow-up inspection within 12 months of when the support starts.
If you enter mandated intensive support on our recommendation, you will also need a recommendation from us before you can exit the programme.
What happens after you exit the programme
When you exit mandated intensive support, NHS England and NHS Improvement will provide you with an exit support package.
At this point, you normally move from segment 4 to segment 3 of the NHS System Oversight Framework.