An NHS trust is an organisational unit within the English National Health Service, 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 healthcare for a resident.
Nature of a trust
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. All trusts (Foundation trusts and those which have yet to reach foundation trust status) are regulated by NHS Improvement. 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. 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 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.
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."
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
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 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
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