National Health Service (NHS) trust

   Trusts have the responsibility for running the range of local NHS services. There are various types, including acute trusts, ambulance trusts, care trusts, mental health trusts, and primary care trusts (PCTs). The 300-plus PCTs are now at the centre of the NHS and control 80 per cent of its budget. As local organisations, they are thought to be in the best position to understand the needs of their communities. Among other tasks, they assess the health needs of their local area, commission the right services to meet these needs (for example, from general practitioners [GPs], hospitals and dentists), ensure the services can be accessed by everyone who needs them, ensure that the services and social-care organisations all work in tandem, take account of patients’ views, and carry out an annual assessment of GP practices in their areas. The PCTs report directly to the strategic health authorities (SHAs). NHS foundation trusts are a new type of NHS hospital run by local managers, staff and members of the public. Only the highest-performing hospitals can apply to become NHS foundation trusts, a status which gives them more freedom in running their services than other NHS trusts. Their creation indicates the shift which is taking place towards delegating decision-making power to front-line staff and the local communities they serve.