An NHS trust is an organisational unit within the

National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...

s of

England England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe ...

and

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

, 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 corporation A state-owned enterprise (SOE) is a government entity which is established or nationalised by the ''national government'' or ''provincial government'' by an executive order or an act of legislation in order to earn profit for the government ...

s. Each trust is headed by a

board Board or Boards may refer to: Flat surface * Lumber, or other rigid material, milled or sawn flat ** Plank (wood) ** Cutting board ** Sounding board, of a musical instrument * Cardboard (paper product) * Paperboard * Fiberboard ** Hardboa ...

consisting of executive and

non-executive director A non-executive director (abbreviated to non-exec, NED or NXD), independent director or external director is a member of the board of directors of a corporation, such as a company, cooperative or non-government organization, but not a member of ...

s, and is

chaired The chairperson, also chairman, chairwoman or chair, is the presiding officer of an organized group such as a board, committee, or deliberative assembly. The person holding the office, who is typically elected or appointed by members of the group ...

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 A foundation trust is a semi-autonomous organisational unit within the National Health Service in England. They have a degree of independence from the Department of Health and Social Care (and, until the abolition of SHAs in 2013, their local st ...

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 the supervision of financial audit, but of systems of

corporate governance Corporate governance is defined, described or delineated in diverse ways, depending on the writer's purpose. Writers focused on a disciplinary interest or context (such as accounting, finance, law, or management) often adopt narrow definitions ...

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 and the Crown Court, are the Senior Courts of England and Wales. Its name is abbreviated as EWHC (Englan ...

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 , mottoeng = "We Follow the Light" , established = 1838 - St Luke's College1855 - Exeter School of Art1863 - Exeter School of Science 1955 - University of Exeter (received royal charter) , type = Public , ...

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 Jeremy Richard Streynsham Hunt (born 1 November 1966) is a British politician who has served as Chancellor of the Exchequer since 14 October 2022. He previously served in the Cabinet as Secretary of State for Culture, Olympics, Media and Sport ...

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 * 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 plan In England, a sustainability and transformation plan (STP) is a non-statutory requirement which promotes integrated provision of healthcare, including purchasing and commissioning, within each geographical area of the National Health Service. The ...

s 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 NHS Foundation Trusts, and deadlines have been set for this transformation, which have repeatedly been missed.

Former types

NHS primary care trust Primary care trusts (PCTs) were part of the National Health Service in England from 2001 to 2013. PCTs were largely administrative bodies, responsible for commissioning primary, community and secondary health services from providers. Until 31 May ...

(PCT) (abolished 1 April 2013), which provided

primary care Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist car ...

services, public health functions and commissioned secondary care services *

NHS care trust A care trust is a type of NHS trust in the English National Health Service and NHS Wales that provides both health and social care. They may carry out a range of services, including social care, mental health services or primary care services. Car ...

(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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