The first eight trusts to be assessed under the Advanced Foundation Trust Programme have been named, with their performance against priority areas of leadership, quality, and financial sustainability to determine whether they will be given greater autonomy and financial freedoms.
Those granted Advanced Foundation Trust status will also be given the opportunity to hold an integrated health organisation (IHO) contract “to oversee the health budget for a defined local population”, based on a separate assessment of their capability and readiness. Designation for IHOs will happen in 2026, with selected organisations to work with NHSE and commissioners to co-develop the model before planned go-live of the first models in 2027.
The eight trusts named so far 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.
According to NHSE, these trusts have shown that they are delivering in terms of public priorities and value for money under the NHS Oversight Framework, additionally being assessed on Care Quality Commission ratings to demonstrate high quality care.
“Advanced foundation trusts will be the new marker of excellence for providers that drive the delivery of the three shifts, bring down waiting lists and work with partners to improve population health,” NHSE states. “Both NHS trusts and foundation trusts will be able to apply for advanced foundation trust status, with those that pass our assessment given greater autonomy and financial freedoms.”
In return for greater autonomy and financial flexibility, trusts will be expected to deliver faster improvements in patient care, waiting times, and productivity, as well as to help drive positive change across the wider NHS. They will also reportedly be independently assessed “at least every five years” to ensure their continued high standards and to encourage continuous improvement.
A consultation is now underway on guidance for applicants for the Advanced Foundation Trust Programme, with an online questionnaire open for responses until the 11 January, 2026.
Wider trend: NHS reform
NHSE published its 2025/26 priorities and operational planning guidance at the beginning of this year, with a focus on local prioritisation and planning, reducing wait times, improving access and patient flow, and more. In the guidance, “greater financial flexibility” was promised for systems in managing their budgets, along with increased local autonomy with support and intervention from NHSE “based on specific needs and performance”.
NHSE shared an update on the NHS Oversight Framework for 2025/26 following a consultation which attracted more than 150 responses, including from ICBs, trusts, and key stakeholders. The framework set out plans to place each ICB and provider into segments from 1 to 4 based on performance against short- and medium-term NHS priorities, with an additional segment, 5, available to those most in need of support.
The UK government published its Fit for the Future: The 10 Year Health Plan for England, aiming to “build a truly modern NHS”, with focus on moving from hospital to community, analogue to digital and sickness to prevention. The plan outlines a new operating model, a new era of transparency, a new workforce model with staff aligned to the direction, a reshaped innovation strategy, and a different approach to NHS finances.
Our HTN Now panel discussions have shared insight, learnings, and best practices from across the health and care sector, with our session on putting Lord Darzi’s findings into action reflecting on what is holding the NHS back from innovation; the challenges and missed opportunities; and the role of digital and tech in driving change, supporting a focus on prevention and promoting integrated care.
