AnNHS trust is an organisational unit within theNational Health Services ofEngland andWales, 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. As of April 2020[update], there were altogether 217 trusts, and they employ around 800,000 of the NHS's 1.2 million staff.[1]
NHS trusts were established under theNational Health Service and Community Care Act 1990 and were set up in five waves. Each one was established by astatutory instrument.
NHS trusts are nottrusts in the legal sense but are in effectpublic sector corporations. Each trust is headed by aboard consisting ofexecutive andnon-executive directors, and ischaired by a non-executive director. There were about 2,200 non-executives across 470 organisations in the NHS in England in 2015.[2] Non-executive directors are recruited by open advertisement. All trusts (foundation trusts and those which have yet to reach foundation trust status) are regulated byNHS England and theCare Quality Commission. Board members are, from November 2014, subject to afit 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 financialaudit, but of systems ofcorporate 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.[3]
TheHigh Court of Justice decided in December 2019 that NHS trusts were not charities for the purposes of theLocal Government Finance Act 1988, so they have to paybusiness rates at the full rate.[4]
A study by theUniversity of Exeter in 2020 found that in 70 out of the 213 trusts all the board members were white. OverallBAME 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.[5]
In September 2015Jeremy 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.[6] SubsequentlySimon 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 byMonitor."[7]
There are several types of NHS trusts:[8]
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 foundation trusts, and deadlines have been set for this transformation, which have repeatedly been missed.[citation needed]
Severalspecial health authorities, organised on a national basis, deal with NHS-wide issues. An example isNHS Blood and Transplant.