An NHS trust is an organisational unit within the

National Health Service The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...

s of

England England is a Countries of the United Kingdom, country that is part of the United Kingdom. It is located on the island of Great Britain, of which it covers about 62%, and List of islands of England, more than 100 smaller adjacent islands. It ...

and

Wales Wales ( ) is a Countries of the United Kingdom, country that is part of the United Kingdom. It is bordered by the Irish Sea to the north and west, England to the England–Wales border, east, the Bristol Channel to the south, and the Celtic ...

, generally serving either a geographical area or a specialised function (such as an ambulance service). In any particular location there may be several trusts involved in the different aspects of providing healthcare to the local population. , there were altogether 217 trusts, and they employ around 800,000 of the NHS's 1.2 million staff.

History

NHS trusts were established under the National Health Service and Community Care Act 1990 and were set up in five waves. Each one was established by a statutory instrument. NHS trusts are not trusts in the legal sense but are in effect public sector corporations. Each trust is headed by a board consisting of executive and non-executive directors, and is chaired by a non-executive director. There were about 2,200 non-executives across 470 organisations in the NHS in England in 2015. Non-executive directors are recruited by open advertisement. All trusts ( foundation trusts and those which have yet to reach foundation trust status) are regulated by NHS England and the Care Quality Commission. Board members are, from November 2014, subject to a fit and proper person test. All trust boards are required to have an audit committee consisting only of non-executive directors, on which the chair may not sit. This committee is entrusted not only with the supervision of financial

audit An audit is an "independent examination of financial information of any entity, whether profit oriented or not, irrespective of its size or legal form when such an examination is conducted with a view to express an opinion thereon." Auditing al ...

, but of systems of

corporate governance Corporate governance refers to the mechanisms, processes, practices, and relations by which corporations are controlled and operated by their boards of directors, managers, shareholders, and stakeholders. Definitions "Corporate governance" may ...

within the trust. Hospital board members have a duty to act on signals of poor performance on quality and safety data, and yet many of the papers presented to them have been found to be lacking good data visualisations. The

High Court of Justice The High Court of Justice in London, known properly as His Majesty's High Court of Justice in England, together with the Court of Appeal (England and Wales), Court of Appeal and the Crown Court, are the Courts of England and Wales, Senior Cour ...

decided in December 2019 that NHS trusts were not charities for the purposes of the Local Government Finance Act 1988, so they have to pay business rates at the full rate. A study by the

University of Exeter The University of Exeter is a research university in the West Country of England, with its main campus in Exeter, Devon. Its predecessor institutions, St Luke's College, Exeter School of Science, Exeter School of Art, and the Camborne School of ...

in 2020 found that in 70 out of the 213 trusts all the board members were white. Overall BAME representation at board level was 8.9%. Medical directors of BAME ethnicity accounted for 19.4%, about the same as the overall percentage of BAME doctors.

Future development

In September 2015 Jeremy Hunt was reported as saying "I think we do have too many trusts as independent organisations" in a context where mergers between trusts and the establishment of chains of hospitals were being discussed. Subsequently Simon Stevens made it clear that he did not expect the remaining NHS trusts to become foundation trusts, saying "We are frankly kidding ourselves if we think the non-FTs are going to pass the kinds of criteria that have been set by Monitor."

Types

There are several types of NHS trusts: *Hospital trust (also known as an acute trust), which provides secondary care services *

Mental health trust A mental health trust provides health and social care services for people with mental health disorders in England. There are 54 mental health trusts. They are commissioned and funded by clinical commissioning groups. Patients usually access th ...

* Ambulance services trust * Community health trust Over time the distinction between different types has eroded, and both hospital and mental health trusts have taken on responsibility for various community services. Sustainability and transformation plans all propose to move services out of hospitals into the community and the hospital trusts are generally planning to follow these initiatives.

Foundation trusts

Foundation trust status may be applied for by the above categories of NHS trust. Successive governments have announced that all NHS trusts should become foundation trusts, and deadlines have been set for this transformation, which have repeatedly been missed.

Former types

* Primary care trust (PCT) (abolished 1 April 2013), which provided

primary care Primary care is a model of health care that supports first-contact, accessible, continuous, comprehensive, and coordinated person-focused care. It aims to optimise population health and reduce disparities across the groups by ensuring equitable ...

services, public health functions and commissioned secondary care services * Care trust (abolished 1 April 2013), provided/commissioned health and social care services, usually with responsibilities of both a PCT and a local authority

Other types of NHS organisation

Several special health authorities, organised on a national basis, deal with NHS-wide issues. An example is NHS Blood and Transplant.

References

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