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What are NHS Foundation Trusts?

The introduction of NHS Foundation Trusts represents a profound change in the history of the NHS and the way in which hospital services are managed and provided.

NHS Foundation Trusts are a new type of NHS Trust in England. They are part of the Government’s plan for creating a patient-led NHS. The aim of these reforms is to provide high quality care, shaped by the needs and wishes of today’s patients, in the most efficient way. NHS Foundation Trusts have been created to devolve decision-making from central Government to local organisations and communities so they are more responsive to the needs and wishes of their local people. They are also at the leading edge of many of the other reforms and improvements that are creating a patient-led NHS.

NHS Foundation Trusts are no longer subject to direction from the Secretary of State for Health. Instead, NHS Foundation Trusts establish stronger connections between themselves and their local communities. Those living in communities served by a hospital of an NHS Foundation Trust can become a member of that organisation. The membership community of each NHS Foundation Trust is made up of local people and staff, with patients and carers also having the option to become a member.

Members are able to stand and vote to elect representatives, to serve on the Board of Governors. Governors are responsible for representing the interests of the members and partner organisations in the local health economy in the running of the NHS Foundation Trust. Local communities and staff working on the front line can therefore have a bigger say in the management and provision of NHS services in their area. NHS Foundation Trusts can in turn direct their services more closely to their communities, with freedom to develop new ways of working so that hospital services more accurately reflect the needs and expectations of local people.

Although run locally, NHS Foundation Trusts remain fully part of the NHS. They have been set up in law under the Health and Social Care (Community Health and Standards) Act 2003 as legally independent organisations called Public Benefit Corporations, with a primary purpose to provide NHS services to NHS patients and users according to NHS principles and standards. The public still receive healthcare according to core NHS principles – free care, based on need and not ability to pay.

NHS Foundation Trusts operate within a clear accountability framework. They are accountable locally to their members through the Board of Governors. And to commissioners – including NHS Primary Care Trusts – for the delivery of NHS services via legally binding agreements. NHS Foundation Trusts are also accountable to Monitor (the Independent Regulator of NHS Foundation Trusts) who oversees and monitors them against their terms of authorisation, and has powers to intervene. NHS Foundation Trusts are not being left to sink or swim and cannot ‘cherry pick’ services or pursue organisational goals at the expense of the needs of their local health community.