Description
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 (and, until the abolition of SHAs in 2013, their local strategic health authority). As of March 2019 there were 151 foundation trusts.
History
Foundation trusts were announced by Health Secretary Alan Milburn in 2002, and the legislative basis was the Health and Social Care (Community Health and Standards) Act 2003. The first ten NHS hospitals to become foundation trusts were announced in 2004. Gordon Brown prevented plans by Alan Milburn that they should be financially autonomous in 2002. By 2012, the Monitor website listed 145 foundation trusts.
Successive governments set target dates by which all NHS trusts were supposed to have reached foundation status. For example, by 2009 the Department of Health was promoting "A new type of NHS hospital". In 2011, the 116 trusts then in the pipeline to make applications were required to sign a formal agreement, with a deadline for the application to be made. Board members at a number of trusts which missed the deadline were sacked.
It was accepted by Andrew Lansley that a number of trusts would never reach foundation trust status, and a new organisation – the NHS Trust Development Authority – was established by the Health and Social Care Act 2012 to supervise trusts which have not reached foundation status, of which there were 99 in April 2013, 47 of which were never expected to reach foundation status.
The Health and Social Care Bill 2011, overseen by Lansley, proposed that all NHS trusts become foundation trusts or part of an existing foundation trust by April 2014.
The early foundation trusts were generally financially buoyant, but during 2013 and 2014 more faced financial difficulties. A foundation trust finance facility, managed by an advisory committee to the Department of Health, was established to process loans for capital developments, but during 2014 applications were made by trusts which had trouble paying utility bills or replacing medical equipment. Guidance issued under the tenure of Jeremy Hunt in October 2014 said that conditions could be set which could include: reductions in the use of temporary staff, "use of collaborative procurement routes" or "the adoption of a shared services solution". By the end of 2013–14, foundation trusts collectively had built up cash reserves of £4.3 billion and it was suggested in the NHS Five Year Forward View that the government would "support" foundation trusts to spend this money "to help local service transformation". In response, the chief executive of the Foundation Trust Network, Chris Hopson, said: "The responsibility for these surpluses lies with the FTs; any attempt by the statutory bodies to make a grab for them will be furiously resisted".
By 2016, the distinction between foundation trusts and other NHS trusts was widely regarded as eroded, and in that year the two regulators were combined into a new body, NHS Improvement. The notion that every trust should become a foundation trust was abandoned, and the widespread financial crisis undermined the supposed autonomy when almost all had to rely on money borrowed from the Department of Health, to which strings were attached.
