Editorial

Abstract

By April 1994 only 4% of NHS units remained under the direct management of district health authorities. All the remaining 419 are NHS trusts. It is therefore timely to reflect on the experience of NHS trusts and the papers in this collection are intended to stimulate that reflection. This short introduction to those papers will serve two purposes: Firstly to refresh memories about the government aspirations for NHS trusts at the outset; and secondly to provide a guide to the content of the seven papers.

In January 1989 the government issued the White Paper Working for Patients (DoH, 1989a) which stated its intention to create self-governing hospitals within the NHS. A subsequent working paper gave further details on this proposal which the Department of Health presented as the ‘next logical step in the process of extending local responsibility’ (DoH, 1989b). ‘The working paper indicated that self-governing hospitals would be established under statute as ‘separate legal entities’ with specified ‘extensive powers and freedoms’. The initiation of a trust application was ‘open to a variety of interest – including the health authority, the hospital management team, a group of staff or people from the local community’.