Some take the view that Foundation Trust  governors have no powers and little say. Some staff members think they would have a conflict of interest which stops them being as forthright as they would wish and they risk being painted as simply part of the management.

The reality is that governors can keep their independence and they actually do have considerable power and influence – if they are prepared to fight to use it.  In some trusts they are already taken seriously and play a key role in decision making.  Some trusts have set up mechanisms for governors to be more accountable to members and they are trying hard to make stakeholder governance into a reality.  We should at least force all to be as open and transparent as the best.

We miss opportunities as so many governing bodies have no effective staff representation (though they could have) and the public and appointed governors are usually business people or associated in some way with the management.  Some governors are intimidated by those who are there to be management supporters.

But for those who are prepared to engage the opportunities are there, even if it involves hard work and frustration.  We have to build the support networks and provide the advice activists will need.

The Health & Social Care Act actually strengthens the position of governors.  The key roles which are directly enshrined legally and which offer major scope are:-

  • to appoint (and sack) and appraise non executive directors and the Chair
  • to be consulted over the annual plan and any key strategic developments (no power of veto)
  • to approve a change in the Private Patient Income Cap of greater than 5%
  • to agree any changes in the trust constitution
  • to approve any “significant transactions”.

The Act requires trust boards to meet in public and to publish board papers and agendas even for those parts of their meetings they class as confidential (where the public is excluded).  There are no particular rights given to governors in addition to the public – which is a major omission.

Three things are absolutely essential for governors to be able to fulfil their role:-

  • a joint agreement between board and governors about how governors and then the members are to be kept informed and consulted
  • the right of governors to attend any meeting of the board or its sub committees and to see all papers (obviously bound by the same duty of confidentiality as board members)
  • the right to decide what constitutes a “significant transaction” examples being
    • all contracts over £xm or x% of turnover
    • all programmes or projects which might entail redundancies
    • major clinical service reconfigurations
    • mergers and acquisitions, joint ventures and outsourcing of services
    • any change in level of private patient activity.

In most trusts there are already ways for governors to have constructive discussions with the board. But where boards do not agree to give governors the tools they need to do the job then the governors should complain to the regulator and then commence action through opposing the annual plan and by using their powers to hold non executive directors, including the Chair, to account.

Governors should be asking for meetings with their trust board to consider the new powers and the new opportunities and then ensuring these are properly reinforced by changes to the trust Constitution.  This will make the trust ready for when the new powers come into force.

How can services be made more accountable to patients, public and staff?

Democracy Involvement and Accountability in Health



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  1. AG says:

    I wish joe farrington-douglas would stop writing these ridiculous articles.

    Co-opted governors outnumber those directly-elected. The public reps are usually politically active-political parties get local members to become trust members just to vote to elect their people. The governors are a joke, they do not represent ordinary working class people. Has Mr farrington-douglas met many homeless people at FT board meetings? No, I thought not.

    Meetings are far too infrequent & the governors are bogged down with loads of silly governance documentation, which prevents them holding the board to account. FTs stage manage AGMs, where “members” are given powerpoint presentations about clinical governance or the trusts’ new stop smoking service instead of a proper meeting. FTs dont care what governors or members think. FT membership is just a database of names of hapless victims, who get blitzed with junk mail. Naturally, FT membership gets outsourced to private companies and yet more money gets diverted from direct clinical care to hire PR agencies to produce glossies, telling people how wonderful FTs are.

    You cannot seriously believe that FTs have constructive dialogues with governors. I know of several where relations have completely broken down and others where governors have been dismissed for criticising the trust.

    Governing bodies were never intended to have power, they don’ have power and these new gimmicks will make absolutely no difference. FTs are just going to continue outsourcing and closing NHS services in order to make space for private patients. Most ordinary people dont want private patients in their local NHS hospital and they dont want their FT selling assets or wasting money on rip-off PFIs.

  2. socadmin says:

    1. Joe didn’t write this article. He had nothing to do with it.
    2. Every FT constitution provides that elected governors are in a majority.
    3. If you look at the public governors there are very few who are in any way politically active. Its a pity, as politically experienced people might be an asset.
    4. Its true that I’ve never met a homeless person who was governor. Homeless people probably have more urgent problems to worry about.
    5. Tell us about the governors who have been dismissed please

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