NHS trust and NHS foundation trust

In England, most NHS hospital, mental health, community and ambulance services are run by NHS trusts. A trust is a statutory NHS body with its own board of directors. It is the legal employer of the nurses, doctors and other staff who work in its hospitals and services, which is why job offers, contracts, payslips and visa sponsorship for most international recruits come from a named trust.

Trusts are often described by what they do: an acute trust runs hospitals, a mental health trust runs mental health services, and an ambulance trust runs ambulance services. Some trusts cover several of these.

An NHS foundation trust is a type of trust first created under the Health and Social Care (Community Health and Standards) Act 2003. Foundation trusts are public benefit corporations. Local people, patients and staff can become members, who elect a council of governors. According to NHS England's code of governance for provider trusts, the council of governors holds the non-executive directors to account for the board's performance, and governors represent the interests of members and the public.

NHS trusts that are not foundation trusts do not have members or a council of governors. Both types provide NHS care free at the point of use, follow national NHS standards, and are overseen by NHS England and inspected by the Care Quality Commission.

• Your employer is the trust. Nurses and allied health professionals on Agenda for Change and doctors on national medical contracts are employed by a trust, which also issues local contracts for locally employed doctors.
• Sponsorship. To sponsor you on a Health and Care Worker visa, the trust must be a licensed sponsor and assign a certificate of sponsorship.
• Ethical recruitment. NHS trusts must follow the code of practice for international recruitment.
• Checks. The trust runs your pre-employment checks, including occupational health clearance, right to work and DBS.

Foundation trusts exist only in England. Scotland and Wales run NHS services mainly through regional health boards, and Northern Ireland through health and social care trusts. Pay scales and some employment terms also differ. When you see a vacancy, check which nation and which employer it is with, since this affects pay and terms.

For the wider structure, see our guide to UK healthcare.

• Assuming a hospital name is the employer. One trust often runs several hospitals under different names; your contract is with the trust.
• Assuming foundation status changes pay. Both types usually employ staff on national NHS terms.
• Dealing with unlisted recruiters. Under the code of practice, NHS employers should use only recruitment organisations on the ethical recruiters list, and no recruiter may charge you a fee for finding you work.