Reinventing FTs and creating IHOs: autonomy, accountability and flexibility

On 3 July 2025 the Department for Health and Social Care (DHSC) published the government’s 10-year health plan (10YHP) for England: fit for the future. 

Its section on ‘earned autonomy for providers’ (pp80-84) sets out significant ambitions for trusts. It proposes:

• autonomy, flexibilities and freedoms for providers; 
• a ‘reinvigorated and reinvented’ foundation trust (FT) model; 
• ‘new FTs’;
• new integrated health organisations (IHOs) which will hold a whole health budget for a population; and
• more meaningful support and intervention where providers fail to perform.

This briefing is the product of extensive member engagement, including some who have provided in-depth feedback on the proposals. We include their perspectives directly here as quotes (in italics) and identify questions that those working to implement the plan should seek to answer. We are extremely grateful to those who took the time to inform this briefing.[i]

Please contact Izzy Allen, our senior policy advisor – governance, for more information or to discuss the content of this briefing.