An NHS foundation trust is an NHS trust that is part of the National Health Service in England and has gained a degree of independence from the Department of Health and local NHS strategic health authority.
They have a significant amount of managerial and financial freedom when compared to NHS hospital trusts. The introduction of NHS foundation trusts represented a change in the history of the National Health Service and the way in which hospital services are managed and provided.
This form of NHS trust is an important part of the UK Government's programme to create a "patient-led" NHS. Whilst their stated purpose is to devolve decision-making from a centralised NHS to local communities in an effort to be more responsive to their needs and wishes, others however see the change towards semi-independent hospital boards as a move towards privatisation of the health service.
Foundation Trusts are considered mutual structures akin to co-operatives, where local people, patients and staff can become members and governors and hold the Trust to account. For example, Blackpool Fylde and Wyre Hospitals NHS Foundation Trust has 31 Governors, made up of Appointed, Public and Staff Governors who act as a key link between patients and the public and the Board of Directors.  Some trusts are more committed to co-operative principles and have even written the Rochdale Principles into their constitution and aspire to work closely and in partnership with other mutual as well as local organisations. 
This designation can only apply to trusts providing high secure psychiatric services.
This name suggests, these trusts abide by the same Department of Health definition for a Foundation Trust but there are important differences: the Secretary of State maintains a direct line of communication and accountability with them through their appropriate SHA. This requirement is needed because he has the responsibility to provided healthcare to 'patients' who have been detained, and have been judged, to pose a grave danger to the public (if at large).
Foundation Trust equivalent (FTe): do not have a private patient cap unlike their Foundation Trust counterparts (FT).
FTe governors have no statutory role; unlike their Foundation Trust counterparts.
FTe Board of Directors have no statutory duty towards their governors; unlike their Foundation Trust counterparts.
FTe governors cannot, unless the Board of Directors agree, have any control over the direction of the FTe; unlike their Foundation Trust counterparts.
FTe Board of Directors can make detrimental changes to Trust performance and finance without having to notify the governors; unlike their Foundation Trust counterparts.
FTes are not regulated by Monitor 
FTes can, like FTs; retain surplus cash, they do not have to return this cash to the NHS.
FTes can like FTs; sell property and retain the cash from the sale.
FTe governors cannot appoint or remove trust auditors; unlike their Foundation Trust counterparts.
FTe; Chair and Directors are not appointed by their board of governors; unlike their Foundation Trust counterparts.
In essence the board of governors of a FTe are elected in order that the trust can follow Foundation principles; however, in reality; they have no Statutory roles, therefore they have less real power to effect change than their FT governor counterparts. Any powers that they may gain must be granted by the Executive Board of Directors and can be removed by the same Directors.
Unlike FTs, FTes have NO private patient cap. Meaning that FTes can decide how much private patient work they want to do.
Whilst the Secretary of State has the same clear view and ability to direct the provision of services to this group of patients under the old system, under the new structures that are designed to give the appearance of a patient led NHS, these special controls need to be added as extras, which results in a more complex and greater administrative burden. 
Unlike hospitals outside the NHS, Foundation Trusts have a cap on the proportion of their income that can come from non-NHS treatments, such as from fee-paying patients.
Foundation Trusts are regulated by an independent body, Monitor (NHS).
Foundation Trusts also have different reporting requirements. They produced their accounts under the Foundation Trust Financial Report Manual, which is collated and authorised by Monitor, in liaison with HM Treasury.
By March 2010, the Monitor website listed 129 Foundation Trusts.
The introduction has not been without its critics. Some pointed out that Foundation Trusts go against the spirit of the principles laid out by Aneurin Bevan (who founded the NHS). Others said that it will lead to a two-tier system, as in Canada, and whilst the quality of healthcare in their system is excellent, the World Health Organisation has discovered it has the longest waiting times for any developed country. Worse, for those that can no longer afford private insurance, accessing it through the publicly funded side proves most difficult with many not succeeding. Another doubt is about whether the Foundation Members will actually succeed in having any effective influence over the hospital management. History seems to have proved that since the 1600s, entry process into the higher echelons of medicine (and especially those of surgeons and physicians) has a countertendency of selecting those who are by nature steadfastly resistant to accepting guidance and advice from outside their profession. A further concern is that Foundation Trusts will quickly copy the USA and come to see some conditions as more profitable, and concentrate on those at the expense of others. The 2007 WHO report found that despite expenditure being almost double of the UK, the resulting outcomes were no better. 
|“||I regret to say that I wouldn't be able to pinpoint a particular point or issue that I have been able to achieve by my being a governor.||„|
—Homerton University Hospital governor quoted anonymously
Another report found, was that it is too easy to invite members to sit on sub-committees, where they quickly become bogged down in the minutiae of operational planning, whilst the main decisions are taken at meetings that they only come to hear about after they have happened.  This study was funded by the Nuffield Foundation and was echoed in British Medical Journal, as was The King's Fund findings.
|“||If governors have little real influence it will be hard to claim that foundation trusts represent a leap forward||”|
— anonymous governor,