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.
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