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The first NHS trusts

57 trusts

57 NHS trusts were established on 1 April 1991. NHS trusts were established by the National Health Service and Community Care Act 1990. The Act gave the secretary of state powers to establish NHS trusts by order.

These trusts were to assume responsibility for the ownership and management of hospitals or other facilities, which were previously managed or provided by regional, district or special health authorities.

'Self-governing' trusts had greater freedoms to borrow money, generate income and raise revenue directly from providing services.

Later developments and controversy

On 16 October 1991, the Secretary of State for Health, William Waldegrave, announced an additional 99 trusts would be established from 1 April 1992. An additional four London teaching hospitals would be established from 1 April 1993.

During a parliamentary debate in 1991, the Opposition suggested that the proposal to create trusts so close to the 1992 election had been an irresponsible one, given the widespread opposition to the policy:

'How can the Rt Hon Gentleman, in the fag end of this Parliament, invite hospital managers and health staff to go through the upheaval in the next six months of preparing for trust status when the government know that every other party will oppose it in the election that must follow?' (Robin Cook, 16 October 1991).

Later, the Health and Social Care (Community Health and Standards) Act 2003 provided for the establishment of NHS foundation trusts (a new form of NHS organisation with greater freedoms than NHS trusts).


House of Commons.
National Health Service and Community Care Act 1990.
leglisation.gov.uk; 1990.

House of Commons.
NHS Trusts HC Deb 16 October 1991 vol 196 cc311-28.
Hansard; 1991.