NHS trust

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An NHS trust is an organisational unit within the National Health Services of England and Wales, 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, there were altogether 217 trusts, and they employ around 800,000 of the NHS's 1.2 million staff. [1]

Contents

History

NHS trusts were established under the National Health Service and Community Care Act 1990 and were set up in five waves. Each one was established by a statutory instrument.

NHS trusts are not trusts in the legal sense but are in effect public sector corporations. Each trust is headed by a board consisting of executive and non-executive directors, 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. [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 by NHS England and the Care Quality Commission. Board members are, from November 2014, subject to a fit 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 financial audit, but of systems of corporate 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]

The High Court of Justice decided in December 2019 that NHS trusts were not charities for the purposes of the Local Government Finance Act 1988, so they have to pay business rates at the full rate. [4]

A study by the University of Exeter in 2020 found that in 70 out of the 213 trusts all the board members were white. Overall BAME 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]

Future development

In September 2015 Jeremy 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] 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." [7]

Types

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 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 foundation trusts, and deadlines have been set for this transformation, which have repeatedly been missed.[ citation needed ]

Former types

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.

See also

Related Research Articles

An NHS foundation trust is a semi-autonomous organisational unit within the National Health Service in England. They have a degree of independence from the Department of Health and Social Care. As of March 2019 there were 151 foundation trusts.

<span class="mw-page-title-main">NHS primary care trust</span>

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 2011, they also provided community health services directly. Collectively PCTs were responsible for spending around 80 per cent of the total NHS budget. Primary care trusts were abolished on 31 March 2013 as part of the Health and Social Care Act 2012, with their work taken over by clinical commissioning groups.

Berkshire Healthcare NHS Foundation Trust provides mental health services and other community based health services, primarily to the resident population of the Royal County of Berkshire, England, in the United Kingdom.

Healthcare in the city of Bristol, England and the surrounding area is largely provided by the National Health Service (NHS). Until July 2022, this was provided through the Bristol, North Somerset and South Gloucestershire clinical commissioning group. Facilities include a large teaching hospital – Bristol Royal Infirmary – which offers nationally commissioned specialist cardiac, cancer and children's services from its city-centre campus to patients in the southwest of England and beyond.

Frimley Health NHS Foundation Trust is an NHS Foundation Trust created on 1 October 2014 by the acquisition of Heatherwood and Wexham Park Hospitals NHS Foundation Trust by Frimley Park Hospital NHS Foundation Trust. This was the first ever take over of one NHS Foundation Trust by another. It runs Heatherwood Hospital in Ascot, Wexham Park Hospital near Slough, both in Berkshire, and Frimley Park Hospital near Camberley, Surrey.

Healthcare in Dorset was primarily the responsibility of Dorset Clinical Commissioning Group until July 2022. Dorset County Council is leading in the development of an electronic health record, to be called the Dorset Care Record, provided by Orion Health. It is intended to enable all health and social care providers to share records.

Healthcare in Worcestershire was the responsibility of three Clinical Commissioning Groups until July 2022, covering, respectively Redditch and Bromsgrove, Wyre Forest and South Worcestershire.

Healthcare in Somerset, England was the responsibility of three clinical commissioning groups (CCGs) until July 2022. These covered the ceremonial county of Somerset, which comprises the areas governed by the three unitary authorities of Somerset, North Somerset and Bath and North East Somerset.

Healthcare in Sussex is the responsibility of NHS Sussex, an integrated care system and the NHS Sussex Partnership NHS Foundation Trust.

Healthcare in Staffordshire was the responsibility of six clinical commissioning groups until July 2022, covering Stafford & Surrounds, North Staffordshire, South East Staffordshire and Seisdon Peninsula, East Staffordshire, Cannock Chase, and Stoke-on-Trent.

Healthcare in Cornwall was until July 2022 the responsibility of Kernow clinical commissioning group, until it got replaced by Integrated care system, as a result of the Health and Care Act 2022. As far as the NHS is concerned, Cornwall includes the Isles of Scilly.

Healthcare in the West Midlands was, until July 2022, the responsibility of five integrated care groups: Birmingham and Solihull, Sandwell and West Birmingham, Dudley, Wolverhampton, and Walsall.

Healthcare in Surrey, England was the responsibility of five Clinical Commissioning Groups: East Surrey, North West Surrey, Surrey Downs, Guildford and Waverley, and Surrey Heath from 2013 to 2020 when East Surrey, North West Surrey, Surrey Downs, Guildford and Waverley merged to form Surrey Heartlands CCG. The new organisation started with a £62 million deficit.

Healthcare in Gloucestershire was the responsibility of two clinical commissioning groups, covering Gloucestershire and South Gloucestershire, until July 2022. The health economy of Gloucestershire has always been linked with that of Bristol.

Healthcare in Northumberland was the responsibility of the Northumberland, Newcastle Gateshead, and North Tyneside clinical commissioning groups from 2013 to 2022 before being replaced by integrated care systems.

<span class="mw-page-title-main">NHS Improvement</span> Non-departmental health service oversight body in England

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 to give patients consistently safe, high quality, compassionate care within local health systems that are financially sustainable.

Healthcare in Northamptonshire was the responsibility of Northamptonshire Clinical Commissioning Group until July 2022, with some involvement of Cambridgeshire and Peterborough CCG.

Healthcare in Yorkshire from 2016 was the responsibility of 19 clinical commissioning groups, which were replaced by integrated care systems in July 2022.

Healthcare in Lincolnshire was, until July 2022, the responsibility of integrated care systems covering Lincolnshire West, Lincolnshire East, North East Lincolnshire, North Lincolnshire, and South Lincolnshire.

In England, an integrated care system (ICS) is a statutory partnership of organisations who plan, buy, and provide health and care services in their geographical area. The organisations involved include the NHS, local authorities, voluntary and charity groups, and independent care providers. The NHS Long Term Plan of January 2019 called for the whole of England to be covered by ICSs by April 2021. On 1 July 2022, ICSs replaced clinical commissioning groups in England.

References

  1. ↑ Hopson, Chris (15 April 2020). "Confronting coronavirus in the NHS: Foreword". NHS Providers . Retrieved 16 April 2020.
  2. ↑ "Make the most of non-executives and the independent sector". Health Service Journal. 28 May 2015. Retrieved 17 June 2015.
  3. ↑ Schmidtke, Kelly Ann; Poots, Alan J; Carpio, Juan; Vlaev, Ivo; Kandala, Ngianga-Bakwin; Lilford, Richard J (31 March 2016). "Considering chance in quality and safety performance measures: an analysis of performance reports by boards in English NHS trusts". BMJ Quality & Safety. 26 (1): bmjqs-2015-004967. doi:10.1136/bmjqs-2015-004967. hdl: 10044/1/30454 . PMID   27034337. S2CID   841266.
  4. ↑ "Councils welcome 'common sense' tax victory over NHS trusts". Health Service Journal. 12 December 2020. Retrieved 23 February 2020.
  5. ↑ "One in three trusts have entirely white boards". Health Service Journal. 9 September 2020. Retrieved 25 October 2020.
  6. ↑ "The NHS has 'too many trusts', says Hunt". Health Service Journal. 9 September 2015. Retrieved 22 October 2015.
  7. ↑ "Stevens: Funding growth may depend on 'transformation' plans". Health Service Journal. 13 October 2015. Retrieved 22 October 2015.
  8. ↑ "NHS authorities and trusts". The NHS in England. NHS Choices. 28 January 2013. Retrieved 7 November 2013.

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