Open to question

That October, my contract as a non-executive director of a trust expired. In January this year, I learned it would not be renewed. Now that I was 'just' a member of the public, I wondered what observing other trusts' board meetings was like. How do you find out about them? How easy is it to attend? Do you feel more involved in the health service? Do you feel you have 'a greater voice' in how your taxes are spent on health? I decided to find out.

I selected 12 trusts in and around Manchester. They included specialist, whole-district, acute and community trusts. I chose those where I thought I would not know any of the board members (except for one convenor).

I telephoned each trust headquarters and asked:

are the board meetings open to the public?

what is the date and time of the next one?

where will it be held?

Seven trusts gave all the information in one telephone call. With the five others I needed perseverance. One did not answer until my third attempt; another took three separate calls before the information was found; at a third I had to prise details out of my informant, who rambled and said they liked to know how many people were coming; at a fourth, there was uncertainty about the meetings being open: could I ring back later? I did, and got the date and time, but not full details of the venue: I was asked to give my name and address for information to be sent.

At one trust, there was misunderstanding about my purpose in calling. It was assumed I wanted to hire the boardroom, which led to lengthy confusion. When I established I only wanted information about board meetings, my informant said: 'That might be difficult.' But I got details in the end.

Although everyone I spoke to was friendly and polite, I felt that, as an 'unknowing' member of the public, I might have been put off.

Three of the 12 informants mentioned that only part of the meeting was open to the public. One said: 'You do know you'll be kicked out at half time, don't you? All meetings have a public and private part.'

I asked for the same information at community health councils local to each trust. Six CHCs cover the relevant area. Three were very helpful and found the information quickly. In one case, my informant knew the dates and times required but not the venues. She offered to find out and ring me back immediately. At another, I received more information than I had been given at the trust concerned. I was told that I could go on the trust mailing list.

Three were unhelpful. One I rang three times and got no reply. Another could find no details and asked me to ring later. When I did, it still had no details. With another (which I asked about several trusts), my informant was willing to search out details of one of them. But the information she gave me differed from that given by the trust itself, and proved to be wrong. She said I should ring the other trusts myself.

I went to 11 of the 12 venues, but attended only nine of the meetings. I went to one trust for 1pm, the time stated by the chief executive's office, but the meeting was not until 5pm. I then discovered that these meetings alternated (1pm one month, 5pm the next.)

One meeting began at 9.30am, all the others between 1pm and 5.30pm. Only one trust had a notice outside the building about the board meeting. Once in the building, it was not always easy to find the boardroom. Four were in buildings without receptionists. Once, I was given clear instructions downstairs where to find the boardroom, only to be confronted upstairs by 'keypad' doors. Only three of the nine trusts displayed any information about the meeting on or near the boardroom door, and in two of these cases the starting times given were different from those I had.

So at five of these nine meetings I found myself loitering in corridors or knocking on doors, seeking help, either unsure that I was in the right place or unclear about the starting time. My most straightforward arrival was when a cheery receptionist called: 'Going to the board meeting? First left at the top of the stairs: they're all up there.'

Once inside the boardroom, there was a feeling of welcome at six trusts: chairs either shook hands and introduced themselves, or extended a general welcome to the public. One passed me a note of welcome with an invitation to ask questions later, and another asked the entire board to introduce themselves round the table 'as we have a member of the public here'. At these friendly meetings, board members smiled, acknowledged the observers and offered refreshments if they were having them. At three meetings the welcome was more muted and many board members ignored our presence.

I spent a lot of time guessing who the board members were. Sometimes, names were displayed on the table but half the members had their backs to me so that their names faced their colleagues, who presumably knew them already. The chair, chief executive and finance director were always easily identifiable, but who were the rest? One chief executive kindly sent me a handwritten seating plan of the table.

The average number of observers was three (range: two to eight) but only one other was a 'real' member of the public: the rest were either CHC, union or press representatives, or PR people connected with the trust. The smallest boardroom had room for only two or three observers: in the largest, three of us had 35 chairs to choose from.

My policy was not to ask for any board papers but to wait to see what was offered. Every official observer brought papers. At four meetings, I received an agenda and full supporting papers. These were either handed to me at the beginning or left out on chairs. One board gave me a 'welcome' sheet with basic facts about the composition and role of the trust board, its statutory committees, and the trust management structure, together with all tabled documents.

At one trust, I was handed only a single-sheet agenda. I was told that another observer had the papers and it was suggested that I might ask to 'have a look at them' before the meeting began.

At four meetings, papers were neither offered nor obviously available in the room. By the last occasion this had become infuriating. Without an agenda I had no idea of the scope of the meeting, no indication of its possible length and no markers to see where we were up to.

Without supporting papers (at five of the nine meetings) my being there was almost useless. Many board members spoke quietly and many sat with their backs to us. Although I listened hard, waited for clues, gathered scraps of information and tried to piece things together, there were many things I simply did not catch. At one meeting, I had hardly any idea what was being discussed. When people said things like, 'I think the report is self-explanatory', or, 'You will see what the position is on page 5', the sense of exclusion was almost complete.

It is difficult to say how much jargon was being used since, after four years in the NHS, I am familiar with it. Perhaps if a member of the public had the relevant documents they might work out what CPNs, PAMs, and DNAs were.

I stayed to the end of eight of the nine meetings (range: 40 - 120 minutes).

Four offered no opportunity for the public to comment or ask questions. Either a formal, hostile-sounding resolution, excluding the public, was read out, or the chair said something like, 'We'll take a five-minute break', and everyone got up.

At the other four there was an opportunity for questions at the end, then the chair thanked the public for coming. At three very friendly meetings, the CHC representatives sat at the end of the board table throughout and, at two of these, were invited to comment at the end of every item.

Overall, I was impressed by the apparent competence of these boards. But I did not feel 'more involved' or that I had 'a greater voice' by attending their meetings. If observers are to gain anything from open sessions, trusts should:

advertise the meetings;

make sure staff can give accurate information;

provide clear directions to the boardroom;

put a notice on or near the boardroom door;

arrange the room so that people can hear and, if possible, see the board members;

devise some method of identifying members;

ensure everyone has relevant documentation;

allow some comments and questions;

offer refreshments if board members have them;

attend other trust board meetings, unannounced, to see if their own might be improved.