NHS foundation trusts

An NHS foundation trust is, like all NHS trusts, part of the NHS. A foundation trust provides medical services according to the core principles of the NHS: free care based on need, not the ability to pay. Anyone who lives in the area, works for a foundation trust, or has been a hospital patient or service user there, can become a member of the trust. 

These members elect the council of governors. Members and governors are the centrepiece of the foundation trust's accountability and governance. 

Foundation trusts: the key principles

NHS foundation trusts are:

  • public benefit corporations, a legal form unique to foundation trusts but based on NHS traditions
  • led by an independent board of directors
  • authorised and regulated by an independent regulator, known as Monitor
  • accountable to local communities through a system of local ownership
  • accountable to local commissioners, who contract with them to deliver medical services
  • free from central government control and performance management, while striving to exceed the standards that all NHS organisations must achieve, including being licensed by the Care Quality Commission
  • not required to break even each year – though they must be financially viable. They can borrow money within limits set by the regulator, retain surpluses and decide on service developments and innovations for their local community
  • accountable to Parliament, where they must lay their annual reports and accounts.

It is anticipated that all NHS trusts will become foundation trusts over the next three to five years.

Monitoring NHS trusts: the regulator Monitor

Monitor is the sector regulator for healthcare services in England. Their job is to protect and promote the interests of patients by ensuring that the whole sector works for their benefit. 

Find out more about Monitor's work with NHS trusts.

Connecting foundation trusts: NHS Providers

There are 145 authorised NHS foundation trusts, made up of 99 acute healthcare providers, 41 mental health organisations and four ambulance trusts. The sector spends £31 billion a year and currently has 480,000 employees. Nearly two million people have joined a foundation trust and there are now more than 4,200 elected governors.

Find out more about NHS Providers and how it connects foundation trusts.