NHS trust

NHS trusts were started in 1990 by Margaret Thatcher's government. The idea was to bring a market into the National Health Service in England and Wales.  They took the place of District health authorities which had managed the services before. 

Each trust has a board with managers. After 2002 many of them became foundation trusts.  They had more freedom.  The plan was that they would all become foundation trusts, but that hasnt happened.  

In 2015 there were 470 trusts.  They have been joined to make bigger organizations. In April 2020 there were 217 trusts, with about 800,000 employees.   There are only 3 trusts in NHS Wales.  In Northern Ireland there are 5 health and social care trusts. 

After 2017 there was less talk about markets in the NHS. Integrated care systems were started. 

About 65% of a trust's money goes on paying the workers.   

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