A survey of foundation trust governors by regulator Monitor reveals the distance still to travel to develop effective governance.
Governors are a crucial part of the foundation deal - more freedom from the centre and the region in return for strong local accountability and rigorous Monitor oversight.
One of the main findings of the survey is that almost a fifth of governors were dissatisfied with the support they received from the executive board, with a small number confessing they were poorly informed about the trust's activities.
Governors can exercise significant powers - they can hire and fire the chair and non-executive directors, for example. But to do this they are highly dependent on the executive team to empower them with the data to ask the tough questions and engage in the full range of the trust's strategic priorities.
In theory, at least, local people are supposed to reinforce accountability through becoming foundation trust members. But the survey reveals that, according to governors, only one in two trusts are good at communicating with the local community. There are huge obstacles to making foundation trust membership anything other than a fig leaf of accountability, but it is still vital trust executives get out and talk to their communities.
As well as explaining what they are doing and why, each trust has its part to play in shedding light on how the NHS tries to balance its conflicting priorities, and illuminating complex issues such as service reconfiguration.
All this is more than just window dressing. The freedoms foundation trusts have been granted are still subject to the vagaries of central policy making. The greater the degree to which these trusts are anchored locally, the greater the protection from being swept back towards the strategic health authority and central government control.