This paper draws upon sociological theory to demonstrate that the manufacture and deployment of trust is an integral part of the function of complex systems such as health care. The discussion begins by identifying the error within the nursing literature which arises from a rather technical conceptualization of trust. This tends to limit the dimensions to trust which is established, and fails to recognize that trust may be subject to competition and conflict. The paper continues by drawing upon the work of two theorists, Niklas Luhmann and Susan P. Shapiro, to demonstrate how trust functions within systems such as health care and the mechanisms through which it is controlled. The title of this paper, ‘Towards a politics of trust’, identifies that this is merely the first stage in the analysis. Further stages are necessary which analyse the ways in which power is exercised in the conflict for control within discrete elements of the system.