Daily Insight: The ghostly governors

It’s surprising there weren’t more public rows of the kind that surfaced this week between the governors of a foundation trust and the rest of the board/NHS England.

Back when David Sloman was in charge of the London NHS, his avowed policy was to have “fewer players on the pitch” by sharing chairs across trusts wherever possible. The theory is this made regional decision-making easier.

Very hard to tell if this policy has had positive or negative effects (what did independent chairs do that necessitated their removal?) but it was certainly widespread in the capital, although the idea took less readily in the rest of the country.

Trust chairs are directly appointed by and can be removed by NHSE. With the chairs of FTs, an approval or dismissal needs to be agreed by the governors, who are elected.

Take a moment to think how many FT governors you can name (trust chairs who are also lead governors don’t count). Thought so. They’ve not had any sort of a profile for more than a decade now because they rarely, if ever, seem to have dissented from the central view of what should happen.

That, or their behind-the-scenes influence has been so discreet that no one has ever mentioned it.

Governors were supposed to give local accountability back when the idea was FTs would be free-roaming enterprises unfettered by the dead hand of the Department of Health and Social Care.

In practice the benefits of FTs were mixed (at best) and the oversight record of governors is unproven (at best – did governors avert any of the disasters at FTs over the past 15 years?)

Where the governor role has been consequential is in some mental health trusts where they are a link between service users and the organisation.

One of the notable things about this case in north London is that Camden & Islington FT’s former chair moved to Queen Victoria Hospital in Sussex, the only other trust where governors are known to have made a stand against a reconfiguration they disapprove of (although in this case the consultants were also against it).

The ultimate waiting list

Integrated care bosses have admitted that adults are facing “exceptionally high” waits of more than a decade for NHS assessment for ADHD in their area, the longest known wait for such services nationally.

Herefordshire and Worcestershire integrated care board wrote in board papers that there were unacceptably long waiting times for ADHD assessment and treatment for Worcestershire patients of more than 10 years, with workforce challenges and “service fragility” compromising delivery of diagnostic services.

HSJ understands approximately 2,000 people are on the waiting list in Herefordshire and Worcestershire – predominantly adults. The ICB said the “current trend in increasing referrals indicates that adult patients seeking an ADHD diagnosis could potentially face a wait time of up to 10 years”, with a spokesman warning such a scenario is “unacceptable”.

It comes as national waits for ADHD and autism assessments continue to cause concern, with 140,000 people waiting more than the National Institute for Health and Care Excellence-recommended 13 weeks for an autism assessment as of April 2023.

Average waits across several integrated care systems for ADHD and autism diagnosis services currently stand at over a year, for both children and adults, with many warning of average waiting times between 13 and 18 months.