NHS Foundation Trust

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NHS Foundation Trusts (often referred to as "foundation hospitals") are hospitals which are part of the National Health Service in England.


They have a significant amount of managerial and financial freedom when compared to existing NHS Trust. The introduction of NHS Foundation Trusts represents a change in the history of the National Health Service and the way in which hospital services are managed and provided.

This form of NHS Trust is an important part of the UK Government's programme to create a "patient-led" NHS. Whilst their stated purpose is to devolve decision-making from a centralised NHS to local communities in an effort to be more responsive to their needs and wishes, others however see the change towards semi-independent hospital boards as a move towards privatisation of the health service.[1]

Foundation Trusts are considered mutual structures akin to co-operatives, where local people, patients and staff can become members and governors and hold the Trust to account. Some trusts are more committed to co-operative principles and have even written the Rochdale Principles into their constitution and aspire to work closely with other mutual organisations. [2]

NHS foundation trusts are authorised and regulated by Monitor, the Independent Regulator of NHS Foundation Trusts. A full list of NHS foundation trusts can be found on their website. [3]


The introduction has not been without its critics. Some point out that Foundation Trusts go against the spirit of the principles laid out by Aneurin Bevan (who founded the NHS) and which made it universally envied around the world.[1] Others have pointed out that it will lead to a two-tier system as in Canada, and whilst the quality of healthcare in their system is excellent, the World Health Organisation has discovered it has the longest waiting times for any developed country. Worse, for those than can no longer afford private insurance, accessing it through the publicly funded side proves most difficult with many not succeeding.[4] Another doubt, is whether the Foundation Members will actually succeed in having any effective influence over the hospital management. History seems to have proven, that since the 1600s entry process into the higher echelons of medicine (and especially those of surgeons and physicians) has a counter tendency of selecting those -who are by nature- steadfastly resistant to accepting guidance and advice from outside their profession. A further concern, is that Foundation Trusts will quickly copy the USA and come to see some conditions as more profitable, and concentrate on those at the expense of others. The 2007 WHO report found that despite expenditure being almost double of the UK, the resulting outcomes were no better. [5][4]

Also, there exists every possibility that individual Foundation Members can be misled to voting with the management due simply to their medical ignorance. For example: Lay people may be easily led to believe that spending money on a new scanner, then spending more money on using it for frequent screening for cancer will improve survival rates. However, all that happens is that earlier detection starts the clock ticking earlier. Therefore, whilst the clock runs for longer it is without the benefit of overall increases in real and absolute survival times - but it looks good in the performance tables. However, the expenditure on such high technology may well take money away from many more less spectacular, but more life-prolonging and more life-enhancing services in other healthcare areas.

A study undertaken by the King's Fund of Homerton University Hospital NHS Foundation Trust found the governors disappointed and disillusioned.

I regret to say that I wouldn't be able to pinpoint a particular point or issue that I have been able to achieve by my being a governor.

—Homerton University Hospital governor quoted anonymously

Another report found, was that it is too easy to invite members to sit on sub-committees, where they quickly become bogged down in the minutiae of operational planning, whilst the main decisions are taken at meeting that they only come to hear about after they have happened. [6] This study was funded by the Nuffield Foundation and was echoed in British Medical Journal, as was The King's Fund findings.

If governors have little real influence it will be hard to claim that foundation trusts represent a leap forward
— anonymous governor, [7]

The older existing NHS system was praised in 2007 by the documentary maker Michael Moore in his film Sicko.

See also

Further reading

  • Pollock, Allyson (2005-09-21). NHS plc : the privatisation of our health care. Verso Books. pp. pages 75-295. ISBN 978-1844675395. Unknown parameter |coauthors= ignored (help)


  1. 1.0 1.1 Unison. "Foundation Trust Watch". Retrieved 2007-09-15.
  2. South London & Maudsley NHS Trust. Our bold vision. Accessed 2007-09-16
  3. Monitor: Independent Regulator of NHS Foundation Trusts Public Register of NHS Foundation Trusts. Accessed 2007-09-16
  4. 4.0 4.1 World Health Organisation (2007-09-16), The World health satistics (PDF)
  5. WHO survey (2007) Graphical representation of different outcomes and expenditure. Accessed 2007-09-16
  6. Brettingham, Madeleine (2005). "Local control over foundation trusts is "rhetoric"". British Medical Journal. doi:10.1136/bmj.330.7505.1408-d. Retrieved 2007-09-16.
  7. Day, Michael (2005). "Foundation hospitals are not accountable to their communities". British Medical Journal. doi:10.1136/bmj.331.7522.926.

External links

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