The paper is a critical review of the problems and implications of trust and in managing health in the British health system. It is a system in need of strong management in the light of the global downturn in recently. Despite of policies on leadership in health in the UK, the macro issues for why the needs of diverse groups are not met are difficult to understand at particular levels of analysis. The central problem has been lack of ‘trust’ relations. The paper detangles the implications of different forms of trust in order to understand health relations in health contexts which has implications for practitioner, policy makers and medical personnel.