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</li> <li id="toc-Former_types" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Former_types"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Former types</span> </div> </a> <ul id="toc-Former_types-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Other_types_of_NHS_organisation" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Other_types_of_NHS_organisation"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Other types of NHS organisation</span> </div> </a> <ul id="toc-Other_types_of_NHS_organisation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>See also</span> </div> </a> <ul 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class="vector-pinnable-header-toggle-button vector-pinnable-header-pin-button" data-event-name="pinnable-header.vector-appearance.pin">move to sidebar</button> <button class="vector-pinnable-header-toggle-button vector-pinnable-header-unpin-button" data-event-name="pinnable-header.vector-appearance.unpin">hide</button> </div> </div> </div> </nav> </div> </div> <div id="bodyContent" class="vector-body" aria-labelledby="firstHeading" data-mw-ve-target-container> <div class="vector-body-before-content"> <div class="mw-indicators"> </div> <div id="siteSub" class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Self-governing administrative body within the National Health Service</div> <p>An <b>NHS trust</b> is an organisational unit within the <a href="/wiki/National_Health_Service" title="National Health Service">National Health Services</a> of <a href="/wiki/England" title="England">England</a> and <a href="/wiki/Wales" title="Wales">Wales</a>, 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<sup class="plainlinks noexcerpt noprint asof-tag update" style="display:none;"><a class="external text" href="https://en.wikipedia.org/w/index.php?title=NHS_trust&action=edit">[update]</a></sup>, there were altogether 217 trusts, and they employ around 800,000 of the NHS's 1.2 million staff.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=NHS_trust&action=edit&section=1" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>NHS trusts were established under the <a href="/wiki/National_Health_Service_and_Community_Care_Act_1990" title="National Health Service and Community Care Act 1990">National Health Service and Community Care Act 1990</a> and were set up in five waves. Each one was established by a <a href="/wiki/Statutory_instrument_(UK)" title="Statutory instrument (UK)">statutory instrument</a>. </p><p>NHS trusts are not <a href="/wiki/Trust_law" class="mw-redirect" title="Trust law">trusts</a> in the legal sense but are in effect <a href="/wiki/Public_sector_corporation" class="mw-redirect" title="Public sector corporation">public sector corporations</a>. Each trust is headed by a <a href="/wiki/Board_of_directors" title="Board of directors">board</a> consisting of <a href="/wiki/Executive_director" title="Executive director">executive</a> and <a href="/wiki/Non-executive_director" title="Non-executive director">non-executive directors</a>, and is <a href="/wiki/Chairman" class="mw-redirect" title="Chairman">chaired</a> by a non-executive director. There were about 2,200 non-executives across 470 organisations in the NHS in England in 2015.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Non-executive directors are recruited by open advertisement. All trusts (<a href="/wiki/Foundation_trust" class="mw-redirect" title="Foundation trust">foundation trusts</a> and those which have yet to reach foundation trust status) are regulated by <a href="/wiki/NHS_England" title="NHS England">NHS England</a> and the <a href="/wiki/Care_Quality_Commission" title="Care Quality Commission">Care Quality Commission</a>. Board members are, from November 2014, subject to a <a href="/wiki/Fit_and_proper_person_test" class="mw-redirect" title="Fit and proper person test">fit and proper person test</a>. </p><p>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 <a href="/wiki/Audit" title="Audit">audit</a>, but of systems of <a href="/wiki/Corporate_governance" title="Corporate governance">corporate governance</a> 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.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>The <a href="/wiki/High_Court_of_Justice" title="High Court of Justice">High Court of Justice</a> decided in December 2019 that NHS trusts were not charities for the purposes of the <a href="/wiki/Local_Government_Finance_Act_1988" title="Local Government Finance Act 1988">Local Government Finance Act 1988</a>, so they have to pay <a href="/wiki/Business_rates_in_England" title="Business rates in England">business rates</a> at the full rate.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>A study by the <a href="/wiki/University_of_Exeter" title="University of Exeter">University of Exeter</a> in 2020 found that in 70 out of the 213 trusts all the board members were white. Overall <a href="/wiki/BAME" class="mw-redirect" title="BAME">BAME</a> 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. <sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Future_development">Future development</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=NHS_trust&action=edit&section=2" title="Edit section: Future development"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In September 2015 <a href="/wiki/Jeremy_Hunt" title="Jeremy Hunt">Jeremy Hunt</a> 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.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Subsequently <a href="/wiki/Simon_Stevens_(civil_servant)" class="mw-redirect" title="Simon Stevens (civil servant)">Simon Stevens</a> 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 <a href="/wiki/Monitor_(NHS)" title="Monitor (NHS)">Monitor</a>."<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Types">Types</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=NHS_trust&action=edit&section=3" title="Edit section: Types"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are several types of NHS trusts:<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Hospital trust (also known as an <b>acute trust</b>), which provides <a href="/wiki/Secondary_care" class="mw-redirect" title="Secondary care">secondary care</a> services</li> <li><a href="/wiki/Mental_health_trust" title="Mental health trust">Mental health trust</a></li> <li><a href="/wiki/Ambulance_services_trust" class="mw-redirect" title="Ambulance services trust">Ambulance services trust</a></li> <li><a href="/wiki/Community_health_trust" title="Community health trust">Community health trust</a></li></ul> <p>Over time the distinction between different types has eroded, and both hospital and mental health trusts have taken on responsibility for various community services. <a href="/wiki/Sustainability_and_transformation_plan" title="Sustainability and transformation plan">Sustainability and transformation plans</a> all propose to move services out of hospitals into the community and the hospital trusts are generally planning to follow these initiatives. </p> <div class="mw-heading mw-heading3"><h3 id="Foundation_trusts">Foundation trusts</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=NHS_trust&action=edit&section=4" title="Edit section: Foundation trusts"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Foundation_trust" class="mw-redirect" title="Foundation trust">Foundation trust</a></div> <p>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.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2013)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Former_types">Former types</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=NHS_trust&action=edit&section=5" title="Edit section: Former types"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Primary_care_trust" class="mw-redirect" title="Primary care trust">Primary care trust</a> (PCT) (abolished 1 April 2013), which provided <a href="/wiki/Primary_care" title="Primary care">primary care</a> services, public health functions and commissioned <a href="/wiki/Secondary_care" class="mw-redirect" title="Secondary care">secondary care</a> services</li> <li><a href="/wiki/Care_trust" class="mw-redirect" title="Care trust">Care trust</a> (abolished 1 April 2013), provided/commissioned health and social care services, usually with responsibilities of both a PCT and a <a href="/wiki/Local_government_in_England" title="Local government in England">local authority</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="Other_types_of_NHS_organisation">Other types of NHS organisation</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=NHS_trust&action=edit&section=6" title="Edit section: Other types of NHS organisation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Several <a href="/wiki/NHS_special_health_authority" class="mw-redirect" title="NHS special health authority">special health authorities</a>, organised on a national basis, deal with NHS-wide issues. An example is <a href="/wiki/NHS_Blood_and_Transplant" title="NHS Blood and Transplant">NHS Blood and Transplant</a>. </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=NHS_trust&action=edit&section=7" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/List_of_NHS_trusts_in_England" title="List of NHS trusts in England">List of NHS trusts in England</a></li> <li><a href="/wiki/List_of_NHS_Wales_trusts_and_health_boards" class="mw-redirect" title="List of NHS Wales trusts and health boards">List of NHS Wales trusts and health boards</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=NHS_trust&action=edit&section=8" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFHopson2020" class="citation web cs1">Hopson, Chris (15 April 2020). <a rel="nofollow" class="external text" href="https://nhsproviders.org/confronting-coronavirus-in-the-nhs/foreword">"Confronting coronavirus in the NHS: Foreword"</a>. <i><a href="/wiki/NHS_Providers" title="NHS Providers">NHS Providers</a></i><span class="reference-accessdate">. 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Health Service Journal. 9 September 2020<span class="reference-accessdate">. Retrieved <span class="nowrap">25 October</span> 2020</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=One+in+three+trusts+have+entirely+white+boards&rft.date=2020-09-09&rft_id=https%3A%2F%2Fwww.hsj.co.uk%2Fworkforce%2Fone-in-three-trusts-have-entirely-white-boards%2F7028409.article%3F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ANHS+trust" class="Z3988"></span></span> </li> <li id="cite_note-6"><span class="mw-cite-backlink"><b><a href="#cite_ref-6">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation news cs1"><a rel="nofollow" class="external text" href="http://www.hsj.co.uk/news/acute-care/the-nhs-has-too-many-trusts-says-hunt/5090168.article#.VilPbkpup1A">"The NHS has 'too many trusts', says Hunt"</a>. 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NHS Choices. 28 January 2013<span class="reference-accessdate">. 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