The Socialist Health Association is a campaigning membership organisation. We promote health and well-being and the eradication of inequalities through the application of socialist principles to society and government. We believe that these objectives can best be achieved through collective rather than individual action.

We stand for:

  • Universal publicly provided healthcare meeting patients’ needs, free at the point of use, funded by taxation
  • Democracy based on freedom of information, election not selection and local decision making
  • Equality based on true equality of opportunity and progressive taxation

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We campaign for an integrated healthcare system which reduces inequalities in health and is accountable to the communities it serves.  We are affiliated to the Labour Party. Until 1980 we were called the Socialist Medical Association.

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6 Comments

  1. eric watts says:

    This is an item from HSJ with comments on the role of FT Governors – meant to be representatives of the local community, but actually only elected from those who have become members of the local trust.
    It would be more democratic if local residents were all given a vote.
    Governors are vital to a foundation trust’s success

    6 December, 2013 | By Giles Peel, Katy Steward

    Foundation trusts need to be reminded of the important role their governors play and support them to fulfil it, say Giles Peel and Katy Steward

    Since 2003, when the previous Health and Social Care Act created the concept of foundation trust governors, their role has been frequently debated but seen by many as offering only a weak form of accountability.

    ‘Governors are united by the view that they are there to serve and improve their organisations’

    Most agree that this changed with the introduction of new statutory duties for representation and holding non-executive directors to account in last year’s act. However, this change has so far introduced more confusion and uncertainty, not less. So who would be an FT governor now?

    During the course of this year DAC Beachcroft and the King’s Fund have run a joint programme of training for lead governors and had the opportunity to examine first-hand some of the nuances of the role.

    Now, with changes in the sector happening at pace, the governors’ representative role should come to the fore. Governors are united by the view that they are there to serve and improve their organisations and there is no doubt that the repeated, and often negative, media coverage of the NHS spurs them on this regard.

    What is their role? Whether boards see the governors’ primary role as to aplly a rubber stamp or to pose questions depends on individuals, behaviours and personalities to a large degree, even within the boundaries of the new Health Act.
    What’s new?

    First, Monitor will expect boards to be able to answer the questions “How are you monitoring patient and public views?”and “Can you assure yourselves that you understand the impact on the community of proposed changes to services?” Governors have a key role to help in this regard.

    Second, governors and chairs have learnt about the nature of their representative role and most are at ease with the idea, even if they are concerned about how to access members and the public alike. Governors must be comfortable about asking the board if it is doing enough to understand the needs of the community it serves.

    Third, governors are realising that their ability to “hold non-executive directors to account” depends on the relationship they build with the board (and equally the willingness to be held to account depends on the relationship the non-executive directors build with the governors). Anybody can ask questions but not everyone will get a good answer.

    Governors have consistently raised important issue in trusts with serious failing on quality of care, and they must continue to believe that they have a duty to challenge non executive directors when they have reasonable grounds for concern, and to expect a response.

    ‘Governors’ confidence is something that boards could do more to develop: induction is only the start’

    Fourth, unfortunately our experience to date has shown that there are a small number of governors who, for a variety of reasons (and some with good intentions) have decided that disruption and agitation is the best means to achieve their ends. In these circumstances, pragmatic codes of conduct are vital to set the values of the organisation and provide a loose framework for debate and behaviour.

    Effective challenge does not need to be adversarial but involves a variety of skills and emotional intelligence. Governors’ confidence is something that boards could do more to develop: induction is only the start, and boards must satisfy the new duty to equip governors with the requisite skills. Chairs need to set the tone here and set out expectations from both the board and council perspective.
    How to help

    Behaviours: Governors need exceptional moral courage and leadership to tackle and communicate difficult issues and not give up. Lead governors especially need leadership development. We should strive to make governors aware of how to make difficult conversations more, not less, productive by deploying appropriate behaviours.

    Knowing how far to challenge: Governors need to know how to challenge and when to stop. They are not responsible for the operational management of the trust and should not try to second guess the directors. They are expected to satisfy themselves that the boards are making the right decisions, which is why their duty is framed around holding the non-executive directors to account for the performance of the board.

    Finding the common ground: Values are at the heart of governance, as successive codes have shown. Boards and councils of governors should come together around their shared values. NHS boards used to recruit non executive directors on the basis of their local position.

    The “local worthy” model of governance gave way to a skills and relevant experience model, at the same time as FTs set out to improve finances and quality. While a lot of good has come from this, there is still more to be gained by recognising a joint commitment to the locality and restating these as values.

    The picture is mixed. We see a diverse range of people determined to make a difference, navigating their way through complex and often contradictory views of their role and influence. We all need to help.

    Giles Peel is head of health advisory at DAC Beachcroft and Katy Steward is assistant director in leadership at the King’s Fund

    Readers’ comments (3)

    eric watts

    eric watts | 6-Dec-2013 3:09 pm

    The most difficult problem in respect of holding Non Executive Directors ( NEDs) to account and knowing that the right decisions are being made is knowing what the NEDs do and how they influence decisions.
    There are many meetings held and decisions made without governors being present to be able to judge on whether the right decision was made. As a governor I am aware of the outcome of the meetings and time does not allow for governors to question how the decisions were made.
    For governors to be sufficiently well briefed to really know how decisions are made we would need to work more than the EWTD allows.
    In effect most of the information we have access to is from Executive Directors or the chair rather than from NEDs. We have to make our judgments on the basis of limited information and this is the most significant weakness in the system.
    The title itself is misleading, governors do not govern, they only have the opportunity to ask questions and the limited time available at meetings limits how far questioning can proceed.
    There role of the governor is evolving but the potential for governors to contribute to improving the performance of their Trusts is limited by the fact that they are meant to operate through holding NEDs to account.
    The work of the trust is carried out by the staff, managed by the mangers, directed by the executive. The NEDs see little of the front line action – the most important work and the governors have limited access to NEDs. With the best will in the world governors can only make judgments on a highly selected fraction of the work NEDs do.
    The next stage in making governors more effective will need to explore how to bring more of the NED’s work under the scrutiny of the governors. This could be done in many ways, including inviting governors onto all the committees that NEDs sit on, by asking NEDs to provide regular reports of their activities or by inviting them to regular review meetings with governors.

    Unsuitable or offensive?
    sjburnell@focused-on.com

    sjburnell@focused-on.com | 6-Dec-2013 9:41 pm

    Unfortunately, FT’s must deal with a contradiction because DH insists the Chair of the Board is the Chair of the Governors.
    Eric Watts is right, therefore, to say that NED’s must make themselves far more available to their Council of Governors otherwise NEDs will always remain accountable solely to the Chairman.
    But, why should they seek to have two ‘masters’ & how many Chairs will see it in their best interests either?
    Perhaps we should just require Governors to hold the Chairman to account & leave the Chair to deal with the performance of his Executives & NEDs?

    Unsuitable or offensive?

    John Gooderham | 7-Dec-2013 8:25 am

    Tis good to hear again from Giles, who led Western Sussex Hospital to FT, at the start of what was to prove a long journey. I wonder if he’d care to return to see how we’re getting on. There is still a great deal of uncertainty in finding what we Govs can usefully contribute, over and above our statutory duties, and a few feathers have been ruffled as a result, but perhaps that’s no bad thing. The whole concept of accountability remains a tricky one to grasp (at least for me). But the critical friend description, used of School Govs a long tome ago, still seems applicable (at least to me). If that means being a bit awkward, that seems OK (at least to me)

  2. Martin Rathfelder says:

    We produced some ideas about the governance of FTs in 2010
    https://www.sochealth.co.uk/socialist-health-association-policy/nhs-policies/statement-on-foundation-hospitals-2010/

    Are they still good – a lot has happened since then?

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