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 b ...
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
The National Health Service and Community Care Act 1990 (c 19) introduced an internal market into the supply of healthcare in the United Kingdom, making the state an 'enabler' rather than a supplier of health and social care provision.Health and S ...
and were set up in five waves. Each one was established by a
Statutory Instrument
In many countries, a statutory instrument is a form of delegated legislation.
United Kingdom
Statutory instruments are the principal form of delegated or secondary legislation in the United Kingdom.
National government
Statutory instrument ...
.
NHS trusts are not
trusts
A trust is a legal relationship in which the holder of a right gives it to another person or entity who must keep and use it solely for another's benefit. In the Anglo-American common law, the party who entrusts the right is known as the "settl ...
in the legal sense but are in effect
public sector corporations. Each trust is headed by a
board consisting of
executive
Executive ( exe., exec., execu.) may refer to:
Role or title
* Executive, a senior management role in an organization
** Chief executive officer (CEO), one of the highest-ranking corporate officers (executives) or administrators
** Executive dir ...
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 the ...
s, 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
NHS Improvement (NHSI) was a non-departmental body in England, responsible for overseeing the National Health Service's foundation trusts and NHS trusts, as well as independent providers that provide NHS-funded care. It supported providers t ...
. Board members are, from November 2014, subject to a
fit and proper person test
The fit-and-proper-person test or director's test is a test aiming to prevent corrupt or untrustworthy people from serving on the board of certain organizations. First introduced in 2004 for owners and directors of major British football clubs, sin ...
.
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 ...
, 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 th ...
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 of England and Wales, Court of Appeal and the Crown Court, are the Courts of England and Wales, Senior Cou ...
decided in December 2019 that NHS trusts were not charities for the purposes of the
Local Government Finance Act 1988
The Local Government Finance Act 1988 introduced significant reforms to local taxation in the United Kingdom (except Northern Ireland). The old systems of Rates in the United Kingdom, rates were replaced by the Poll tax (Great Britain), Communit ...
, so they have to pay
business rates
Rates are a tax on property in the United Kingdom used to fund local government. Business rates are collected throughout the United Kingdom. Domestic rates are collected in Northern Ireland and were collected in England and Wales before 1990 and i ...
at the full rate.
A study by the
University of Exeter
The University of Exeter is a public university , public research university in Exeter, Devon, England, United Kingdom. Its predecessor institutions, St Luke's College, Exeter School of Science, Exeter School of Art, and the Camborne School of Min ...
in 2020 found that in 70 out of the 213 trusts all the board members were white. Overall
BAME
A number of different systems of classification of ethnicity in the United Kingdom exist. These schemata have been the subject of debate, including about the nature of ethnicity, how or whether it can be categorised, and the relationship betwe ...
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
Monitor or monitor may refer to:
Places
* Monitor, Alberta
* Monitor, Indiana, town in the United States
* Monitor, Kentucky
* Monitor, Oregon, unincorporated community in the United States
* Monitor, Washington
* Monitor, Logan County, West ...
."
Types
There are several types of NHS trusts:
*
Hospital trust
A hospital trust, also known as an acute trust, is an NHS trust that provides secondary health services within the English National Health Service and, until they were abolished, in NHS Wales. Hospital trusts were commissioned to provide these s ...
(also known as an acute trust), which provides
secondary care
Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...
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
An ambulance services trust or ambulance trust is an organisation which provide ambulance services within the National Health Services of England and Wales. There are currently 11 ambulance services trusts in England and Wales. Ambulance services ...
*
Community health trust
As part of the English NHS programme of separating the provision of services from commissioning known as Transforming Community Services a number of community health trusts were established when these services were separated from primary care trus ...
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 care t ...
services, public health functions and commissioned
secondary care
Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...
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
Local government is a generic term for the lowest tiers of public administration within a particular sovereign state. This particular usage of the word government refers specifically to a level of administration that is both geographically-loca ...
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
NHS Blood and Transplant is an executive non-departmental public body of the United Kingdom's Department of Health and Social Care.
It was established on 1 October 2005 to take over the responsibilities of two separate NHS agencies: UK Transplan ...
.
See also
*
List of NHS trusts in England
References
{{Use dmy dates, date=September 2019
National Health Service