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NHS trusts

Recent government policy and legislation

Section of Epidemiology and General Practice, Institute of Psychiatry, De Crespigny Park, London SE5 8AF and Bethlem Royal and Maudsley Hospital, Denmark Hill, London SE5 8AZ

The present paper reviews the restructuring of the NHS that has taken place since 1991, with particular reference to the introduction of self-governing NHS trusts. Established to strengthen the financial management of NHS assets and to contain costs, NHS trusts represent a political solution to the problem of health service funding. Despite the speed of the reforms, there is no evidence yet of any improvement in the cost-effectiveness of resource deployment, and it is too soon to say what effect trusts will have on mental health services. Concem remains that the present reforms will ultimately lead to fragmentation of the NHS.