There are few things that most foundation trust governors vehemently agree on but holding open board meetings is one of them. Sharon Carr-Brown explains why.
In a survey of its membership, the Foundation Trust Governors’ Association found that 80 per cent of their governors thought open board meetings were necessary to do their jobs properly. The government is going to listen to governors – possibly for the first time – so what is all the fuss about?
Local accountability, openness and transparency are important concepts that should underpin both the NHS and foundation trusts. As far as governors are concerned, not having open board meetings was an anomaly that needed fixing.
So why does the Foundation Trust Network so begrudgingly accept this change of direction and feel the need to flaunt its opposition on these pages? According to its own figures, half of foundation trusts already have all or part of their board meetings in public. They’ve managed to find a way to make things work, so I imagine the rest can, too.
Foundation trusts remain publicly funded bodies, part of the NHS and answerable to local people. There is no good reason why their main decision-making meeting should not be held in public.
Our association is not naive. Our amendment to the Health and Social Care Bill makes it clear that we expect a part A and B arrangement because we respect commercial and personnel confidentiality. But there are a range of ways this can be achieved and still include the public and governors to a proper degree.
The most frequent complaint I have had from governors over the past four years as chair of the FTGA is to do with lack of information from and access to the board. Without this crucial relationship functioning well, the foundation trust will flounder. Hiding behind closed meetings, as they did in Mid Staffordshire, will not save anyone.
Scrutiny is a key part of our role and this is impossible without access to papers, people and meetings. By 2014 all trusts are supposed to be foundations and there will be thousands of governors grappling with the NHS, being asked to make key appointments, assess performance and reassure the public over quality and standards. If the scandal at Mid Staffordshire were to happen again, governors would be first in the firing line. How can we ask them to put themselves in that position and then blindfold them?
And if Foundation Trust Network chief executive Sue Slipman is right, and open board meetings result in non-executives feeling unable to challenge their executive colleagues, thank goodness the governors who appoint them are able to see their performance for themselves. It will fall to governors to appoint non-executives who understand the importance of fair and open challenge, observing the corporate spirit but remembering they’re there for the public as well as the trust.
Robert Francis concluded in his first report into Mid Staffordshire that board meetings should be held in public. The Department of Health has long agreed with this view and both sides of the House of Commons are on board. I find the Foundation Trust Network’s opposition perplexing.
What the FTGA finds particularly concerning is how those against open boards have begun to use an analogy that compares foundation trusts with private companies.
Foundation trusts are funded by the public and act for the public. They are not private fiefdoms. But combined with the lifting of the private patient income cap, signs of tie-ups with private sector providers and a desire to be corporate rather than democratically open, someone with a conspiratorial mind might think they have another agenda.
Openness and transparency are central to the new NHS – why should foundation trusts be exempt?
Over the last four years I have seen governors grow in stature and confidence. Where trusts have embraced the model they are now adding real value. Where governors are distrusted and distanced the relationship is dysfunctional and unrewarding for all. But the model does work and will work even better with open board meetings.
HSJ readers reply:
Having lived through events at Mid Staffordshire Foundation Trust since February 2009, we believe we are in a strong position to contribute to the discussion on whether to hold board meetings in public.
Sharon Carr-Brown is absolutely correct in all that she says and we share her concerns about expecting governors and the public to effectively hold their board to account when they meet in private.
On taking up our new posts, we agreed immediately that all meetings would be held in public and this has been an essential part of the journey to restore public confidence at Mid Staffordshire.
It was not enough to see the public as passive observers in meetings. At Mid Staffordshire, the agenda is structured so that at the end of each section, the public can contribute. At the end of the meeting they can evaluate the effectiveness of the meeting, both verbally and by completing a form.
We have also become aware of the importance of recognising the “human impact” of everything we do (or fail to do), and for this reason each meeting starts with a patient story to set the tone and focus of the discussions that follows.
The board has benefited enormously through adopting this approach and it has become a vital part of ensuring we maintain a strong focus on quality care and patient safety.
More importantly, our board recognises very clearly that we are publicly accountable for the delivery of safe, effective care and treatment and the community. Governors and members can see that we take these responsibilities as custodians of their local NHS very seriously.
Sir Stephen Moss, chair; Antony Sumatra, former chief executive, Mid Staffordshire Foundation Trust