How foundation trusts are set up

NHS foundation trusts provide for greater local accountability to patients and service users, local people and NHS staff. The principles behind NHS foundation trusts build on the sense of ownership that many local people and staff feel for their hospital and other health services.

All NHS foundation trusts have a duty to engage with their local communities and encourage local people to become members of the organisation. NHS foundation trusts have to take steps to ensure that their membership is representative of the communities they serve.

As part of the application process to become a foundation trust, NHS trusts are required to set out their detailed proposals for the minimum size and composition of their membership.

Anyone who lives in the area, works for the trust, or has been a patient or service user there, can become a member of an NHS foundation trust. This gives staff and local people a real stake in the future of their hospital.

Members can:

  • receive information about the NHS foundation trust and be consulted on plans for future development of the trust and its services;
  • elect representatives to serve on the council of governors; and
  • stand for election to the council of governors.

The council of governors works with the Board of Directors, which is responsible for the day-to-day running of the foundation trust, to ensure that the foundation trust delivers high quality care and plays a role in helping to set the overall direction of the organisation. Councils of governors are expected to focus on ensuring that NHS foundation trusts listen and respond to the needs and preferences of stakeholders, especially local communities.

Governors’ statutory roles include:

  •  holding the non-executive directors individually and collectively to account for the performance of the board of directors;
  • representing the interests of the foundation trust members and of the public;
  • appointing, removing and deciding the terms of office of the chair and other non-executive directors;
  • approving the appointment of the chief executive;
  • receiving the annual report and accounts, and auditor’s report, at a general meeting;
  • appointing and removing the auditor; 
  • approving increases to non-NHS income of more than 5% of total income;
  • approving acquisitions, mergers, separations and dissolutions;
  • approving changes to the trust’s constitution; and
  • expressing a view on the board’s plans for the NHS foundation trust, in advance of the plan’s submission to Monitor.

The Board of Directors of an NHS foundation trust is responsible for the day-to-day running of the trust and is made up of both executive, for example the chief executive and finance director, and non-executive directors. 

The council of governors does not have an operational role.  Governors are responsible primarily for holding the non-executive directors individually and collectively to account for the performance of the board of directors and for representing the interests of the foundation trust members and of the public.

  • Contact your local NHS foundation trust for more information on how to become a member, governor or non-executive director. A list of NHS foundation trusts, together with contact details, can be found on our NHS foundation trust directory.