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Background to NHS Foundation Trusts

  • Last modified date:
    13 February 2009

NHS Foundation Trusts are a new type of NHS organisation, established as independent, not for profit public benefit corporations with accountability to their local communities rather than Central Government control.

The Secretary of State for Health has no powers of direction over them. NHS Foundation Trusts remain firmly part of the NHS and exist to provide and develop healthcare services for NHS patients in a way that is consistent with NHS standards and principles - free care, based on need not ability to pay. Clinical activity for private patients is strictly limited.

NHS Foundation Trusts have greater freedoms and flexibilities than NHS Trusts in the way they manage their affairs e.g.

  • Freedom from Whitehall control and performance management by Strategic Health Authorities
  • Freedom to access capital on the basis of affordability instead of the current system of centrally controlled allocations
  • Freedom to invest surpluses in developing new services for local people
  • Freedom of local flexibility to tailor new governance arrangements to the individual circumstances of their community

In line with the programme of reforms set out in The NHS Plan, NHS Foundation Trusts give more power and a greater voice to their local communities and front line staff over the delivery and development of local healthcare. NHS Foundation Trusts have members drawn from patients, the public and staff and are governed by a Board of Governors comprising people elected from and by the membership base.

NHS Foundation Trusts are inspected by the Healthcare Commission for compliance with healthcare standards and targets in the same way as all other NHS Trusts. NHS Foundation Trusts are also overseen by an independent regulator called Monitor. Monitor has statutory powers to authorise NHS Trusts as NHS Foundation Trusts, oversee compliance by NHS Foundation Trusts with their terms of authorisation (like a 'licence' to operate) and intervene in the event of significant non-compliance with the terms of authorisation and other statutory obligations.

The creation of NHS Foundation Trusts has played a key role in sustaining the progress the NHS has made in recent years. An independent review carried out by the Healthcare Commission has already shown that NHS Foundation Trusts are making good progress in developing new innovative approaches to providing better quality healthcare services for the benefit of NHS patients, and improving accountability to their local populations.

The first NHS Foundation Trusts were authorised by Monitor in 2004.

The Government is committed to delivering an all Foundation Trust model for the NHS as soon as possible. Strategic Health Authorities (SHAs) are working with their Ambulance trusts to ensure they are in a strong position to apply for NHS Foundation Trust status from April 2009.  To support this commitment, the Department of Health is working with Monitor and Strategic Health Authorities on a national programme called the Whole Health Community Diagnostic Project to help assess the readiness of NHS Trusts to apply.

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