A National Health Service trust is a division within the English NHS generally serving either a geographical area (commonly the nominal service area of a hospital) or a specialised function (such as an ambulance service). In any particular location there may be several trusts involved in the different aspects of healthcare for a resident.
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.
The 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. The Trusts which have not achieved Foundation status are now managed by the NHS Trust Development Authority. 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 supervision of financial audit, but of systems of corporate governance within the trust.
There are several types of NHS trusts:
- NHS hospital trust (also known as an acute trust), which provides secondary care services
- NHS mental health trust
- NHS ambulance services trust
- Community Health NHS Trust
Foundation trust status may be applied for by the above categories of NHS trust. Successive governments have announced that all NHS Trusts should become NHS Foundation Trusts, and deadlines have been set for this transformation, which have repeatedly been missed.
- NHS primary care trust (PCT) (abolished 1 April 2013), which provided primary care services, public health functions and commissioned secondary care services
- NHS 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
- NHS special health authority, organised on a national basis, dealing with NHS-wide issues
- "Make the most of non-executives and the independent sector". Health Service Journal. 28 May 2015. Retrieved 17 June 2015.
- "NHS authorities and trusts". The NHS in England. NHS Choices. 28 January 2013. Retrieved 7 November 2013.