The rapid development of NHS trusts is making unprecendented demands on those responsible for strategic planning and management for which many are unprepared. This manual is based upon the experience of those who have faced the questions and found the answers. It is intended for all those involved in Trust management. The questions are not all board-level strategic questions; some are quite mundane and managerial. However, the questions will have to be asked and the answers will determine what it is like to work within the organization, be one of its patients or a user of its services.