Progress so far with local accountability at NHS foundation trusts is revealed in two reports published this month by Monitor, the independent regulator. This post reproduces information on this issue that appears on the Monitor website here.
Foundation trusts were set up with a unique governance structure which was specifically designed to achieve greater local accountability than had previously been the case in the NHS. They recruit members from the local community, who in turn elect governors to represent their views and hold the trust’s board to account.
The two reports focus on the relationship between foundation trusts and their members, and the role and effectiveness of foundation trust governors. The findings of the report on membership represent the views of foundation trusts, including chairs, chief executives, company secretaries and membership managers. The survey of foundation trust governors also features the views of chairs and chief executives on specific questions.
Overall, the reports suggest there is enthusiasm for and commitment to the foundation trust model of local accountability, highlighting some positive examples of the impact of members and governors, whilst also revealing some areas for improvement.
Current practice in NHS foundation trust member recruitment and engagement is a joint report produced by Monitor, Electoral Reform Research (part of Electoral Reform Services) and Membership Engagement Services.
The report summarises the findings of a survey of NHS foundation trusts to understand the state of play in member recruitment and engagement, and to obtain examples of what has worked well, and less well.
Key findings of the report include:
- Overall there is significant effort being put into member recruitment and engagement by foundation trusts;
- more than 50% of trusts think their members have influenced key issues such as: how the trust communicates with the public and patients; local public consultations; and, changing an existing service;
- there is debate about what engagement means, with some trusts focusing mainly on one-way communications (e.g. a newsletter), while others try to provide more opportunities for members to become actively involved; and,
- governor election turnouts have fallen, so that they are now in line with other membership organisations, and there has been an increase in the number of uncontested seats.
The Survey of NHS Foundation Trust Governors is a follow-up to research commissioned by Monitor in 2007 and the views of governors in this latest report suggest they have made significant progress. The objectives of the survey were to understand how governors feel about their ability to perform their role, and identify potential areas for improvement. Monitor received 1,671 completed questionnaires, representing a 42% response rate.
Key findings from the survey include:
- governors are significantly more likely to have been involved in both statutory duties and engagement activities than was reported in 2007;
- there are a range of achievements cited by governors as having benefited the trust and its patients, such as: representing the community, improving patient care, and challenging the board of directors;
- nearly 9 out of 10 governors say they understand what holding the board to account involves, although only 7 out of 10 feel they have the power to do so;
- there is a discrepancy between the views of governors and those of foundation trust chairs and chief executives, who are less confident in governors’ ability to perform their role;
- governors believe training is important and would like more, in particular on the practical aspects of being a governor, and the roles of different bodies in the NHS; and
- looking to the future, there is willingness among governors to do more, but in order to do so many feel they need more training and possibly some remuneration for their time commitments or compensation for time taken off from work.
Commenting on the launch of both reports, Monitor’s Chair, David Bennett, said:
"Patients and the public need to feel confident that their hospital is in safe hands, so effective membership engagement and the ability of governors to perform their role are both essential. Our role has never been to dictate what engagement should look like, but we encourage trusts to consider these findings, look at what has worked in other trusts, and identify where they might make improvements.
"It’s clear that governors feel they would benefit from further training. Ultimately we believe it is for foundation trusts to meet the requirements of their governors, with support from external organisations where appropriate. Working with partners, we are playing our part in influencing the ongoing development of appropriate training programmes."
You can download the full reports by following the links below: