Published: 05/02/2004, Volume II4, No. 5891 Page 34
Partnership agreements can prevent executive and non-executive directors clashing, says Bob Hudson
In the early 1990s the decision of the Conservative government to remove local authority representatives from health authority boards seemed to spell the end of interest in joint governance.
However, the matter is back in the public eye following a spate of publicity around 'misgovernance' in cases ranging from Climbié and Shipman to Enron and Transworld.
The shift towards partnership working has been largely unaccompanied by serious discussion of the governance implications.As more and more officer-led joint forums have taken greater responsibility for swathes of NHS and local authority money, the position of elected members and non-executives has been at best ambivalent.
Recent government attempts to be more prescriptive have not always allayed suspicion.
With care trusts, for example, local authority interests remain unconvinced they have sufficient corporate membership and are also unsure of the status of their representation.
As elected members on care trust boards, they are formally there to contribute on a personal basis, not as local authority representatives.Much the same seems to apply to local authority governors on foundation trusts, a situation loaded with tension.
And if, as rumoured, the government is interested in rolling out the foundation concept to care trusts, an interesting situation will arise in which a directly elected body delegates functions to an indirectly elected body that may be seen as a rival.
All of this would matter enormously if governing boards were indeed the decisionmaking forums, but it may be that the purpose of boards is to be symbolic rather than instrumental, despite governmentissued guidance placing emphasis on boards' role of achieving decisional coherence.
The symbolic model of board governance suggests their role is to sustain organisational cohesion rather than make decisions - they serve as a symbol of shared working rather than acting as the substantive arena in which decisions are played out.Naturally such a model can only function when all members understand the rules of engagement.
Clarity in partnership agreements does seem a sensible pre-condition for effective shared governance - clarity about who is accountable for what, and how, with clear definition of roles and functions, including how bodies established under section 31 are accountable to boards, cabinets and other governing forums.
However, effective joint working is not basically dependent upon good governance but upon good relationships, and no amount of legal documentation can compensate for a basic lack of trust.
Bob Hudson is senior associate at the Health Services Management Centre, Birmingham University. For more information on these issues: www. integratedcarenetwork. gov. uk