NHS Foundation Trusts, first introduced in April 2004, are different to other NHS trusts. They are independent legal organisations who have their own governance arrangements. They are accountable to local people, who can become members and governors. Each NHS Foundation Trust has a duty to consult and involve a board of governors (including patients, staff, members of the public, and partner organisations) in the strategic planning of the organisation.

They are not regulated by central Government and are no longer performance managed by health authorities. As self-standing, self-governing organisations, NHS Foundation Trusts are in control of their own future.

Foundation Trusts have financial freedom and they can retain monies not spent to invest in improving their Hospital and services.

Foundation Trusts are overseen by Monitor who are a non-departmental public body established in 2004. They are the sector regulator of NHS-funded health care services. Their main duty is to protect and promote the interests of patients.