NHS advanced foundation trusts: 2025 reforms explained
Top NHS performers are set to get more freedom. Health and Social Care Secretary Wes Streeting has announced a new “advanced foundation trust” status for the best‑run hospital and community providers. The aim, set out by the Department of Health and Social Care, is simple: give strong local teams more room to decide how services run and how money is spent so care matches what people in their area actually need.
What that phrase means in plain English: an advanced foundation trust is a provider that has proved it delivers safe, high‑quality care, keeps a steady financial position, and works well with staff and local partners. In return, it can reorganise services more quickly, approve investments faster, and design care without waiting for as many sign‑offs from Whitehall.
NHS England has put forward eight high‑performing organisations for assessment by an independent panel before any status is awarded. They include community and mental health providers as well as a specialist children’s hospital, showing this is not just about big acute hospitals.
What you might notice as a patient or carer: shorter waits where bottlenecks can be fixed locally, more clinics and support in neighbourhood settings, and better use of technology. Think virtual wards for people who can safely recover at home, remote monitoring for long‑term conditions, and shared digital records so you do not repeat your story at every doorway.
The money question matters. Trusts that have been careful with taxpayers’ money and built up savings since last year will be allowed to invest those funds in scanners, ward upgrades or community facilities. If a project is under £100 million, the paperwork should be far lighter, speeding up upgrades that often stall in approvals.
Extra freedom comes with extra responsibility. Ministers expect faster progress on waiting times, productivity and patient experience. Trusts will be reviewed independently at least every five years to keep standards high, and they are expected to support improvement beyond their own patch by sharing what works.
For transparency, NHS England says the first group nominated 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.
Some organisations may also take on Integrated Healthcare Organisation contracts. That means controlling an agreed local health budget and being responsible for improving the health of the whole population, not just running clinics or wards. The idea is to shift more care and money into neighbourhood teams and community services where this prevents hospital stays.
The reform sits inside the government’s 10 Year Health Plan and its three big moves: from treating illness to preventing it, from hospital‑centric care to community care, and from paper to digital. The Department of Health and Social Care frames the change as moving away from command‑and‑control towards trusting strong local leadership. As Wes Streeting put it, “good leadership in the NHS has never mattered more”.
Media literacy check for all of us: greater autonomy is not the same as privatisation. These are still NHS providers using public funds, operating within national rules on safety, equality and access. The practical test is whether local leaders use their extra room to reduce inequalities and make services easier to reach for people who struggle to get care now.
If you work in health or teach young people about public services, the smart questions to ask locally are: how will decision‑making be shared with staff and patients, what data will be published about waiting times and outcomes, and how will community groups be involved in redesigning services? Clear answers signal accountability as autonomy grows.
What happens next is assessment and phase‑in. The nominated trusts will undergo independent scrutiny before any badge is awarded. Those that pass will have to show progress quickly and keep proving it, or risk losing the extra freedom at review. For patients, the takeaway is straightforward: if your local trust makes the list and keeps its promises, you should see faster, more joined‑up care.