One of the recommendations of the Francis report was that the role of foundation trust governors be expanded. An enhanced involvement in the governance of patient safety could be particularly valuable, says Josephine Ocloo

Three business people round a table


Meeting, boardroom

Given the intention that all NHS trusts will be foundation trusts by 2014, the Francis report’s recommendation that governors should have expanded roles will ultimately be relevant across the service.

‘National research has shown that governor involvement varies greatly from organisation to organisation and in many instances is non-existent’

FTs are expressly set up to have a more inclusive governance structure. The management in such organisations are required to consult and engage with an elected council of governors, made up of patients, staff, members of the public and other key stakeholders.

A primary function of the board of governors is to hold non-executive directors individually and collectively to account for the trust’s performance. This duty has been increased following the passage of the Health and Social Care Act, which gives governors greater accountability for performance − including safety and quality.

Participation concerns

However, national research has shown that governor involvement in the governance of patient safety varies greatly from organisation to organisation and in many instances remains non-existent. Fewer than half of surveyed foundation trusts said they involved governors in key patient safety committees.

Research at one site revealed an extensive governance context for managing patient safety involving board, safety and various sub-committees. But governors were mainly excluded from these formal mechanisms and did not sit on any high level safety committees, with participation seen as posing a conflict of interest with the role of governor.

‘A challenge will be how to enable governors to develop a greater degree of scrutiny’

There are some examples of more transparent ways for boards to work. At Northumbria Healthcare Foundation Trust, for example, governors’ involvement in patient safety is strongly supported. They sit on all key safety committees at which no patient-identifiable information is involved.

Governors undergo training similar to that offered to non-executive directors, covering how the trust works and how it deals with patient safety issues. This is reinforced by regular presentations at council of governor meetings. Patient safety days are also run for governors, with multidisciplinary groups of staff addressing specific areas.

Confidentiality agreements

At Norfolk and Suffolk Foundation Trust, every governor receives all confidential board papers (including quality and patient safety reports). Governors sign a specific confidentiality agreement that covers how they will use the information and how they will store and dispose of the papers.

It is clear that for governors to gain the skills, knowledge and experience required to be more closely involved in patient safety, targeted support will be needed. A challenge will be how to enable governors to develop a greater degree of scrutiny, particularly given the limits of their time and capacity as unpaid volunteers.

Supporting FT governor involvement in patient safety

Many FT governors are likely to need support to take on their expanded responsibilities. This could include:

  • Programmes − such as the King’s Fund board leadership for FT governors course − to support skills development and relationship building.
  • Training to cover specialist areas, including patient safety.

There will also be a need for clearer national guidance on the best way for governors to participate in safety committees − specifically, what information it is appropriate to share with them.

Josephine Ocloo is a senior researcher with the patient and family centred care programme at the King’s Fund. She worked on the research described in this article with social researcher Ali O’Shea and Professor Naomi Fulop of King’s College London