Monitoring questions for NHS trusts

Page last updated: 12 May 2022
Organisations we regulate

During the monitoring call our inspector will focus on these specific key lines of enquiry. You can open the questions to see the type of detail they will be interested in.


S1: How do systems, processes and practices keep people safe and safeguarded from abuse?
  • What is the trust’s process for COVID-19 testing for patients?

Does not apply to ambulance trusts. 
For community health services, consider testing for patients in the community/living in their own homes.

  • Was there anything key from the findings of the infection prevention and control board assurance framework?
  • How have safeguarding arrangements changed over the COVID-19 pandemic?
  • What are the themes and trends from recent safeguarding incidents and what action is being taken in response?
  • Mental health trusts only: How has your trust strengthened the governance on reducing restrictive practices to ensure restrictions aren’t being re-created for groups or individuals during COVID-19?
S2: How are risks to people assessed, and their safety monitored and managed, so they are supported to stay safe?
  • Are there realistic and workable plans for managing staff and skill levels if the pandemic leads to shortfalls and emergencies?
  • How is the trust performing against mandatory training targets?


E4: How well do staff, teams and services work together within and across organisations to deliver effective care and treatment?
  • How is the trust working with partners in response to, during and rehabilitation from the crisis? Are there plans for ICP/STP phase 3 system working? What are the challenges and what oversight is in place to ensure that partnership/system working is effective?
  • How is the trust assuring itself that there are protocols in place for how and in what circumstances multidisciplinary team meetings are held, and that they are effective? For example, specifically in relation to cancer services. (does not apply to NHS ambulance trusts)


C1: How does the service ensure that people are treated with kindness, respect and compassion, and that they are given emotional support when needed?
  • How is the trust supporting and engaging with patients and their families/loved ones?
  • How does the trust ensure itself that the care delivered is compassionate and upholds people's human rights? Can you give examples?
  • What are the themes and trends from recent complaints? What action are you taking in response?
  • Does the trust provide suitable accurate information on infections, in a timely way, to people using services, their visitors and any person concerned with providing further support or nursing/medical care? (does not apply to NHS ambulance trusts)
  • Mental health trusts only: How does the trust promote and enable virtual visiting from families for those who are detained in hospital long term?
  • Mental health trusts only: How is the trust maintaining advocacy services for individuals?


    R2: Do services take account of the particular needs and choices of different people?
    • How has the trust ensured compliance with equality and human rights legal requirements for patients during the pandemic?
    • How are services delivered, made accessible and coordinated to take account of the needs of different people, including those with protected characteristics under the Equality Act and those in vulnerable circumstances? This may include:
      • ensuring that each patient’s information and communication needs are identified, recorded, flagged, shared and met
      • identifying and making other reasonable adjustments for disabled people
      • Where new protocols for admission are being used, how are these being communicated to staff and how are they reviewed to ensure they are non-discriminatory?
      • Are datasets complete and timely, to underpin an understanding of and response to inequalities?
    R3: Can people access care and treatment in a timely way?
    • How is the trust managing ongoing access to services and restarting planned procedures and services in an inclusive way to reduce health inequalities and to ensure that high-risk patients/pathways are identified and prioritised appropriately, including re-instating services and handling backlogs of activity?
    • How is the trust developing digitally enabled care pathways in ways that increase inclusion?


    W1: Is there leadership capacity and capability to deliver high-quality, sustainable care?
    • Has there been any impact on leadership capacity as a result of the COVID-19 crisis? Are there plans and mitigations in place should it be affected?
    • Do leaders understand the challenges to quality and sustainability during this period, and can they identify the actions needed to address them?
    • Is there a named executive Board member responsible for tackling health inequalities?
    • Is there a named executive board member responsible for IPC?
    • How stable is board leadership?
    W3: Is there a culture of high-quality, sustainable care?
    • How are you protecting the health, safety and wellbeing of all staff?
    • How are you supporting staff to raise concerns? (FTSU)
    • How do you make sure you comply with equality and human rights legal requirements for staff during the pandemic?
    • Has there been any impact on the culture of the trust in response to the pandemic?
    • How are you progressing your action plan to work towards board and senior staffing to at least match the overall ethnic group composition of the workforce or local community?
    W4: Are there clear responsibilities, roles and systems of accountability to support good governance and management?
    • Is there a systematic approach to ensuring that actions from National Patient Safety Alerts have been implemented?
    • How is the trust maintaining oversight, quality, and governance for sub-contracted services?
    W5: Are there clear and effective processes for managing risks, issues and performance?
    • How has risk management and governance changed as a result of COVID-19?
    • How will the trust ensure that effective performance management processes are in place to manage and reduce backlogs of elective and cancer patients? (does not apply to mental health and ambulance trusts)
    • How has the trust followed up on issues, learning and actions following CQC’s emergency support framework (ESF) call about infection prevention and control (IPC)?
    • How is the trust progressing its review to ensure the completeness of patient ethnicity data by no later 31 December?
    • Combined NHS trusts only: How is the trust managing performance across the range of services?
    W7: Are the people who use services, the public, staff and external partners engaged and involved to support high-quality sustainable services?
    • How is the trust supporting patients and their loved ones/carers to give feedback? How is this feedback used for continuous improvement?
    • How is the trust working with partners in response to or during the COVID-19 crisis?

      What community engagement is the trust carrying out to mitigate risks of COVID-19 for people in particular high-risk groups – such as different ethnic groups, people with long term conditions, older people and people in lower socio-economic groups?

      W8: Are there robust systems and processes for learning, continuous improvement, and innovation?
      • How does the trust assure itself that learning is shared and embedded?
      • Are there any examples of learning in response to a crisis, and beyond, that you would like to share?
      • Are there any examples of innovation?