Health and Social Care Secretary Wes Streeting has announced a new governance route for high‑performing NHS providers. NHS England has nominated eight trusts to be assessed for advanced foundation trust status, a designation intended to give local leaders greater discretion over service configuration and spending to meet local need.
The reform is presented as a shift from central command to locally led improvement. Organisations that meet a high bar on service quality, financial stewardship and partnership working would gain additional autonomy to organise care and deploy resources, within national standards and oversight.
Financial flexibilities sit at the centre of the model. Trusts that have built up savings since last year will be permitted to invest those reserves in equipment, estates and patient care. For proposals under £100 million, the documentation burden will be substantially reduced to accelerate delivery, for example procuring new scanners or upgrading wards more quickly.
In exchange for greater latitude, candidate trusts will be expected to deliver faster progress on waiting times, patient experience and productivity; to collaborate closely with staff and commissioners; and to help spread improvement beyond their own footprint. Delivery must also align with the 10 Year Health Plan’s three shifts: prevention ahead of sickness, community rather than hospital care, and digital‑first services.
Governance and assurance are built into the framework. The nominated providers will be reviewed by an independent panel, and any organisation granted the status will be reassessed at least every five years to maintain standards and encourage continuous improvement.
NHS England’s initial nominations 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.
Ministers say the wider modernisation programme aims to cut duplication and bureaucracy across the service, releasing resources for frontline care. The policy is framed as part of a broader effort to reduce waiting lists, expand community‑based services and narrow health inequalities.
Some providers may also be offered Integrated Healthcare Organisation contracts. These would combine responsibility for local health budgets with accountability for improving population health, supporting a shift of resources from hospitals to neighbourhood and community services.
For operational teams, the signal is that credible, costed schemes under the £100 million threshold should progress more quickly through approvals, subject to local governance. Organisations are expected to evidence strong financial management, engagement with staff and partners, and clear delivery plans tied to patient benefit.
Patients should see care designed more closely around their needs, with shorter waits and better coordination between hospitals, GPs and community teams. The government highlights virtual wards, remote monitoring and shared digital records as technologies intended to support faster, more joined‑up care.