It is ominous when the health secretary won’t deny that a political ideal has been a “damp squib” in practice. And so to foundation trusts’ local accountability, which Andy Burnham spoke to HSJ about in an exclusive interview this week.

Mr Burnham said he wants to see more powerful governors holding foundation trust managers to account.

He is not satisfied that the trade-off originally envisaged between national and local accountability has been realised. And he won’t deny, when asked, that foundation trust membership and local accountability have been a disappointment.

Last year HSJ revealed that turnouts at foundation trust governor elections have almost halved in the past five years, while the proportion of uncontested posts has increased by more than 80 per cent.

Research by the NHS Confederation uncovered a sorry picture of staff governors who felt disempowered and who lacked the skills they needed to scrutinise boards. Those governors may well welcome Mr Burnham’s attention.

But if foundation trusts want to protect their freedoms, they need to make sure they can convince politicians of their accountability.

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Patients shortchanged in local trade-off