NHS England has awarded a new “Advanced Foundation Trust” designation to six healthcare providers, recognising their performance in delivering care, reducing waiting lists and supporting wider health system objectives.

The status has been created to identify the NHS’s highest-performing organisations and to give them greater freedom over how services are managed and developed. The move forms part of a broader effort to shift decision-making away from central oversight and towards local providers that have demonstrated strong results.

The six trusts selected for the designation are Alder Hey Children’s NHS Foundation Trust, Berkshire Healthcare NHS Foundation Trust, Central London Community Healthcare NHS Trust, Dorset Healthcare University NHS Foundation Trust, Northamptonshire Healthcare NHS Foundation Trust and Northumbria Healthcare NHS Foundation Trust.

The group represents a mix of acute, community, mental health and specialist care providers. NHS England said the organisations were chosen because of their ability to maintain high standards of care while also contributing to wider priorities across the health service.

Trusts seeking Advanced Foundation Trust status were assessed through the NHS Oversight Framework, which measures performance against a range of financial, operational and quality indicators. Providers were required to demonstrate value for money, strong delivery against national healthcare priorities and effective partnership working with local organisations.

A further requirement was evidence of consistently high-quality care. This was assessed through Care Quality Commission ratings alongside other quality and performance measures used across the NHS.

The designation brings a significant change in the relationship between the selected trusts and national regulators. Organisations that have met the required standards will be granted greater strategic and operational autonomy, allowing them to make decisions with reduced intervention from central bodies. According to NHS leaders, healthcare providers with established track records are better equipped to address local needs and enhance services swiftly by bypassing extensive central approval steps. This increased flexibility is intended to accelerate critical decision-making regarding resource distribution, workforce strategies, and the redesign of clinical services.

The policy reflects a wider direction of travel within the NHS, with increasing emphasis on local accountability and integrated care. Rather than applying a uniform level of oversight across all organisations, the approach seeks to differentiate between providers according to their performance and capability. Advanced Foundation Trust status also creates a pathway towards a more ambitious model of local healthcare management. Designated trusts will be eligible to apply for Integrated Health Organisation contracts, which would give them responsibility for managing the full health budget for a defined local population.

Under the proposed model, providers would have greater control over how funding is distributed across services, with responsibility extending beyond individual organisations to the broader health needs of communities. The aim is to encourage more coordinated care and stronger links between hospitals, community services, mental health provision and preventive healthcare.

Two of the newly designated trusts are already progressing towards this next stage. Northamptonshire Healthcare NHS Foundation Trust and Northumbria Healthcare NHS Foundation Trust are currently undergoing the secondary assessment process required to secure Integrated Health Organisation status. If approved, the trusts will spend the 2026-27 financial year working alongside commissioners to develop the financial arrangements, governance structures and care delivery models needed to support the new system.

The first integrated budget arrangements are expected to become operational in 2027. NHS England believes the model could provide a framework for more effective use of resources while improving coordination between different parts of the health service. The introduction of Advanced Foundation Trust status marks a further step in the NHS’s efforts to reward strong performance with greater independence. For the six organisations selected, the designation brings recognition of past achievements and the possibility of taking on a broader role in shaping healthcare delivery within their local areas.

Whether the model is expanded more widely will depend on the performance of the initial group and the outcomes achieved through the next phase of integrated budget management. For now, the six trusts will serve as early examples of how increased autonomy may be used within the evolving structure of the NHS.

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