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