NHS foundation trust

NHS Foundation Trusts are a specific type of public benefit corporation within the National Health Service (NHS) in England. They were introduced by the Health and Social Care Act 2003, with the first trusts established in 2004. NHS Foundation Trusts have a degree of independence from the Department of Health and Social Care and are accountable to their local populations through a system of governance that includes members and elected governors. They are tasked with providing high-quality healthcare services, but they have more freedom to decide their own strategy and the way they run their services compared to other NHS trusts.

Overview

NHS Foundation Trusts are part of the NHS, but they differ from other NHS trusts in several key ways. They have greater autonomy and are able to retain any surplus they generate to invest in new services or improve existing ones. They can also borrow money and make decisions about their estate without government approval. This independence is intended to foster a more responsive and innovative approach to healthcare provision.

Members of the public can become members of their local NHS Foundation Trust, giving them the opportunity to influence the trust's decision-making processes. Members elect governors to the trust's board, who are responsible for representing the interests of the members and the public.

Governance

The governance structure of an NHS Foundation Trust includes a Board of Directors and a Council of Governors. The Board of Directors is responsible for the day-to-day running of the trust, while the Council of Governors holds the board to account and represents the interests of the trust's members and the public.

Board of Directors

The Board of Directors typically includes executive directors, who are part of the trust's senior management team, and non-executive directors, who bring an independent perspective. The Chief Executive of the trust is usually a member of the board.

Council of Governors

The Council of Governors is made up of representatives elected by the members of the trust (including patients, staff, and the public), and in some cases, appointed representatives from partner organizations (such as universities or local authorities). The council plays a key role in ensuring that the trust is accountable to the communities it serves.

Financial Autonomy

One of the defining features of NHS Foundation Trusts is their financial autonomy. They are allowed to retain surpluses and borrow money to invest in services and facilities. This financial freedom is intended to encourage innovation and improve efficiency, but it also means that trusts must be financially sustainable.

Challenges and Criticisms

NHS Foundation Trusts have faced various challenges and criticisms. Some argue that the model creates a two-tier system within the NHS, with foundation trusts having advantages over other NHS trusts. There are also concerns about the complexity of the governance model and whether it effectively ensures accountability.

Future Directions

The landscape of NHS Foundation Trusts continues to evolve. Recent policy developments have focused on increasing collaboration between NHS Foundation Trusts and other parts of the health and care system, with an emphasis on integrated care systems (ICSs) designed to improve coordination of services and patient outcomes.

See Also

• National Health Service (England)
• Health and Social Care Act 2003
• Integrated care system