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Foundation Trust status

University Hospitals Birmingham NHS Foundation Trust (UHB) received authorisation to become one of the first NHS foundation trusts in England on 1 July 2004.

UHB has more than 23,500 members and a board of governors which includes members of the public, patients, staff and stakeholders, who have been elected as representatives. Sections 4, 5 and 6 below provide more detail on the board of directors, governors and foundation membership.

What is an NHS foundation trust?

Foundation trusts are a different type of NHS organisation with a stronger local influence.

Foundation trust hospitals are still part of the NHS and will continue to treat patients according to NHS principles of free healthcare according to need, not the ability to pay. Being a foundation trust means that UHB is better able to provide and manage its services to meet the needs and priorities of the local community, as the Trust is free from central government control.

Foundation trusts are different from standard NHS trusts in three important ways. They:

  • have freedom to decide locally how to meet their obligations
  • are accountable to local people, who can become members and governors¬†
  • are authorised and monitored by an independent regulator for NHS foundation trusts

However, foundation trusts will still be accountable to Parliament. The freedoms given to NHS foundation trusts are underpinned by a framework of national standards which will safeguard quality and protect the public interest.

Why do we need NHS foundation trusts?

The UK government wants the NHS to be a service that is properly responsive to patients' needs and which provides fast, convenient, high-quality care. More money is being invested in the NHS, but alongside this extra money, the NHS must reform to become a service shaped around the needs of patients and the skills of clinical staff.

If the reforms are to succeed, they need to be led by local communities and by the NHS professionals delivering services on the ground. So, having put a system of national standards and inspection in place, the government wants to liberate the talents of staff and local communities. Patients, public and staff are more involved in running NHS foundation trusts.

What difference will this make to the public?

For the first time, patients have a way to direct and shape these organisations and to really influence how they are run. Decisions are taken locally, which means foundation trusts are more responsive to the needs of their patients.

The public have true social ownership of their local hospital, with accountability devolved from Whitehall to the local community. They have a say in how a foundation trust hospital is run. Local people have the opportunity to become involved in the running of their NHS foundation trust, with rights to elect or become governors.

How can I get involved?

Local people, patients and NHS staff are all eligible to become members of their local NHS foundation trust. There are three different levels of membership within the Trust, with level three the most active membership role.

Members are able to stand for election to the board of governors of the Trust. The elected board of governors ensure that Trust directors are held to account, on behalf of Trust members, and has helped UHB to establish an important relationship with our community stakeholders.

Will NHS foundation trusts lead to privatisation of the NHS?

Foundation status does not mean privatisation. In fact, foundation trusts are still fully part of the NHS and continue to provide free care at the point of delivery. Foundation trusts are about devolving power to local people in a new form of social ownership. Foundation hospitals are similar to mutual organisations such as co-operative societies and housing associations.

Foundation trusts are also legally prevented from having shareholders and their members can make no profit from them.

How does foundation status affect UHB finances?

As a foundation trust, UHB is able to retain its financial surpluses and borrow capital and use it to improve and develop services for its users.

How are foundation trusts governed?

Foundation trust hospitals have a new form of governance structure. Foundation trust governance involves members, a board of governors (elected by members) and a board of directors.

How are foundation trusts regulated?

An independent regulator was created by the government to oversee the operation of foundation hospitals. Unlike current NHS hospitals, foundation hospitals are not subject to the direction of the Secretary of State but instead are licensed, monitored and regulated by the independent regulator.

Will foundation trusts be able to 'opt out' of the NHS?

Becoming an NHS foundation trust does not represent opting out of the NHS. NHS foundation trusts are fully part of the NHS family, subject to NHS systems of inspection. They treat NHS patients according to NHS principles and NHS standards, but are controlled and run locally, not nationally.

NHS foundation trusts continue to co-operate with the rest of the NHS.

Last reviewed: 11 September 2023