What Is an NHS Foundation Trust? How It Differs from an NHS Trust
Foundation trusts are still fully part of the NHS, but they have more freedom and local accountability. Here is how they work and what the 2026 Health Bill would change.
Updated · 5 min read
An NHS foundation trust is an NHS hospital, mental health, community or ambulance organisation that has more freedom over its finances and decisions than an ordinary NHS trust, and is accountable to local people through members and a council of governors. Foundation trusts are still fully part of the NHS: care is free in the same way, and they must meet the same standards. A Health Bill introduced in 2026 proposes major changes to how they are governed.
Where foundation trusts came from
Foundation trusts were first set up in 2004. One trust's governor guide, from Lincolnshire Partnership NHS Foundation Trust, explains that the aim was for NHS organisations to make more decisions locally, have more financial freedom and be more accountable to local people.
Many hospital, mental health and ambulance providers in England have become foundation trusts. You can usually tell from the name, such as "University Hospitals Sussex NHS Foundation Trust".
How foundation trusts differ from NHS trusts
| NHS trust | NHS foundation trust | |
|---|---|---|
| Part of the NHS | Yes | Yes |
| Care free at the point of use | Yes | Yes |
| Financial freedom | More central control | More freedom over money and investment |
| Members | No | Yes, local people, patients and staff |
| Council of governors | No | Yes, currently required by law |
| Board of directors | Yes | Yes |
Foundation trusts still have to be financially viable and meet the standards that all NHS organisations must meet, and they are inspected by the Care Quality Commission like other providers.
Members and governors
Members
A foundation trust has members. Membership is usually open to local people, patients, service users, carers and staff. Many trusts make staff members automatically when they join. Being a member is free and lets you vote in governor elections, stand as a governor and hear about the trust's plans.
The council of governors
Governors represent members and the public. A council usually includes:
- public governors, elected by public members
- staff governors, elected by staff
- appointed governors from partner organisations, such as local councils, universities or charities
According to a government guide for governors, their duties include holding the non-executive directors to account for the board's performance and representing the interests of members and the public. Governors also appoint the chair and non-executive directors, and approve the appointment of the chief executive.
The board of directors
The board runs the trust day to day. The council of governors does not manage the trust, but it plays an important part in its governance.
What the 2026 Health Bill would change
In May 2026 the government introduced a Health Bill to put parts of its 10 Year Health Plan into law. According to a summary by law firm DAC Beachcroft, the Bill would:
- abolish NHS England and transfer its functions to the Secretary of State for Health and Social Care
- remove the requirement for foundation trusts to have councils of governors, constituencies and members
- allow failing foundation trusts to be converted back into NHS trusts in cases of serious failure
These are proposals until the Bill becomes law, and the details may change as it passes through Parliament. Until then, foundation trusts must keep their governors and members. Check your trust's website or Parliament's bills website for the latest position.
The 10 Year Health Plan also introduced the idea of "advanced foundation trusts", high-performing trusts that may be given more freedoms in future.
Does it matter to patients?
For most patients, the type of trust makes little visible difference. Treatment is free in the same way, and you have the same rights under the NHS Constitution, including choice of hospital for many referrals and maximum waiting times.
Does it matter to staff?
NHS staff at foundation trusts are usually employed on the same national terms, such as Agenda for Change, and are in the NHS Pension Scheme. Foundation trusts have some freedom over local policies, such as recruitment and retention payments. Staff can also become members and stand as staff governors while that system remains.
Becoming a governor
If you are a member, you can usually stand for election as a public or staff governor. Governors are typically volunteers who attend council meetings, talk to members and the public, and question the non-executive directors about how the trust is performing. Trusts usually provide training for new governors.
If you are interested, look for "governors" or "membership" on your trust's website. Elections are usually advertised to members. Because the 2026 Health Bill would remove councils of governors once it becomes law, check how long any new governor terms are expected to run.
How to find out more about your local trust
- Annual report and accounts: every trust publishes these, showing its performance and finances.
- Board papers: many trusts publish papers for board meetings, and some meetings are held in public.
- Care Quality Commission reports: the CQC inspects and rates NHS trusts and publishes its findings.
- Patient feedback: you can read and leave reviews of hospitals on the NHS website.
Foundation trust questions
Is a foundation trust private?
No. Foundation trusts are public NHS organisations. They are not privately owned.
Can I become a member of my local foundation trust?
Usually yes, if you meet its membership rules, such as living in its area. Look for "membership" on the trust's website.
Sources
Checked on 14 October 2026:
- Lincolnshire Partnership NHS Foundation Trust: LPFT as a foundation trust
- GOV.UK (Monitor): Brief guide for NHS foundation trust governors (PDF)
- DAC Beachcroft: The Health Bill 2026: 10 things you need to know
- GOV.UK: The NHS Constitution for England
This guide explains the general rules for staff in England using 2026/27 figures. It is not financial advice. Your employer, payslip or NHS Pensions statement has the final word on your own pay.