Eight Trusts Selected for New “Advanced Foundation Trust” Status in Shift Toward Local Autonomy

The government has named eight NHS trusts as candidates for a new “advanced foundation trust” designation, marking the first stage of a reform programme intended to give high-performing organisations greater autonomy over finance, delivery and local decision-making. The trusts, drawn from across acute, community and mental health services, will now undergo assessment to determine whether they meet the criteria for the new status, which aims to reward strong governance and operational performance.

The programme is designed to shift the system away from what ministers have described as a “command and control” model and towards a structure in which the most capable providers have additional freedoms to accelerate improvement. Trusts achieving the designation would be able to exercise wider discretion over budgets, service redesign and local investment, with the intention of strengthening elective recovery, expanding community-based care and addressing health inequalities more effectively.

A move toward differentiated oversight

While all trusts remain part of the national accountability framework, the introduction of an advanced foundation trust tier marks a deliberate attempt to recognise variation in performance and provide room for innovation. Officials have indicated that organisations demonstrating consistent delivery, strong leadership and robust governance could help model new approaches for the wider system, particularly in areas such as demand management, neighbourhood services and proactive care.

The eight trusts selected for assessment are Berkshire Healthcare NHS Foundation Trust; Dorset Healthcare University NHS Foundation Trust; Central London Community Healthcare NHS Trust; Northamptonshire Healthcare NHS Foundation Trust; Northumbria Healthcare NHS Foundation Trust; Alder Hey Children’s NHS Foundation Trust; Norfolk Community Health and Care NHS Trust; and Cambridgeshire Community Services NHS Trust. Their inclusion reflects a mix of community, mental health and specialist providers, many of which have been recognised nationally for quality and operational performance.

Testing new models of population-level responsibility

Two of the nominated organisations, Northamptonshire Healthcare and Northumbria Healthcare, will also be assessed for eligibility to hold Integrated Health Organisation (IHO) contracts. This model would allow a provider to take responsibility for the local health budget for a defined population, shifting emphasis away from episodic care and towards population health, prevention and neighbourhood-based services.

If approved, these trusts would gain the ability to shape investment, redesign pathways and commission care across system boundaries, linking financial responsibility more directly to outcomes. The move aligns with broader ambitions for integrated care systems to develop locally-led approaches that combine primary care, community services and acute pathways around population needs.

A signal of the NHS’s direction of travel

The introduction of advanced foundation trust status forms part of a wider reform effort aimed at strengthening local leadership while maintaining clear national priorities. The approach suggests a future in which trusts with proven capability are expected to model new forms of financial sustainability, partnership working and service redesign, potentially informing policy decisions across England.

For the trusts nominated, the assessment period offers an opportunity to demonstrate readiness for greater autonomy and to shape what the new designation will mean in practice. For the wider NHS, the programme reflects a system gradually moving towards more flexible oversight, differentiated responsibilities and a stronger emphasis on outcomes beyond hospital walls.

As assessments progress, attention will turn to how these freedoms are applied and whether they translate into measurable improvement in waiting times, community care, and population health: key tests for whether the model can be scaled more widely across the health service.