Getting on my soapbox on the theme of trust: what’s in a name, and do you trust your local NHS Trust?

AIMS Journal, 2024, Vol 36, No 3

By Jo Dagustun

I’m worried about the way we are compelled to recognise and refer to much of our local NHS service as an ’NHS trust’.¹ I’m uncomfortable about the connotations of the word trust in this context. I don’t think I want to refer to NHS trusts in this way.

What’s in an organisational name? How do the - generally self-selected - names of organisations impact on the way we are able to relate to and ‘know’ an organisation? Do they give sufficient space for us to make our own minds up about what the organisation is, does and represents? Or are they simply a way to seduce us into believing (consciously or not) exactly what they want us to believe about their organisation?

But here we are in England, with a situation that forces us to engage, at least at some level, with a conceptualisation of NHS trusts as organisations that are inherently trustworthy - ones we should trust. Of course, I’m working with the everyday language of trust here. I have not tracked down any discussions at the time of NHS trust development about the use of the word trust in this context. A quick wiki search tells me that “NHS trusts are not trusts in the legal sense but are in effect public sector corporations”.²

Working alongside maternity service users and advocates for improved maternity services, I know that many service users don’t feel that they can trust NHS maternity services. Rather, for them, memories of time spent engaging with their local trust are ones of mistrust. It annoys, upsets or possibly infuriates to have to recognise an organisation, which for them is untrustworthy, as a trust. None of this is unique to maternity services.

Personally, I have come to dislike having to refer to local NHS services in their organisational form as trusts. It feels like a particular kind of gaslighting. We all know that trust is not something that any organisation can demand from others. Trust must be earned.

Where next?

I have learnt in preparing this piece that NHS trusts have been in place since 1991,³ and that it would take legislation to remove the word ‘trust’. I accept that legislation and rebranding costs time and money that would be better used for other purposes. So it’s unlikely that we’d be able to change the names of our local healthcare services to remove the word trust, even if there was a strong call to do so. We are where we are.

So for me, going forward, I’d like instead to see a focus on the extent to which trusts - and parts of trusts - are trusted by their local communities. Do individual trusts measure this? As near-monopoly providers, do they care? We hear much talk of organisational focus on (generally defensive) reputation management, but I’m not sure at all that this is the same thing.

If anything in this article resonates with you, please get in touch. I would love to hear your views.

Author bio: Jo Dagustun has been an AIMS Volunteer since 2017 and lives in Greater Manchester.

This article was written in response to AIMS putting out a call for a Journal contribution on the subject of trust. Jo had a soapbox moment ready and waiting! Perhaps you do too? If so, please get in touch with our editor.