• Review finds “dissatisfaction” with relationship between board and its governors
  • Governors felt they received information after decision had already been made
  • But NEDs felt “cross-examined” by governors’ questions

Relations between an NHS trust board and its council of governors broke down amid a “them and us” environment, an independent review has found.

A report into the relationship between Surrey and Borders Partnership Foundation Trust’s board and its governors said there had been a “breakdown of trust” between governors and board members.

The report, written last year and released to HSJ under the Freedom of Information Act, found “a dissatisfaction with the relationship as it currently operates, with a belief that concerns about the relationship were not being fully addressed. 

“Overall there was a feeling that there had been a breakdown of trust between the council and the board, although within this there were a number of governors and board members who reported positive individual relationships,” added the report, which was carried out by Marie Gabriel, chair of East London Foundation Trust and Norfolk and Suffolk FT.

The review, which was commissioned by SABP chair Ian McPherson, found “unhelpful views and behaviours, perceived or actual, continued to occur, with a ‘them and us’ environment being fostered, leading to the council believing that the board was defensive and the board feeling like the council misunderstood its motivation”.

While Ms Gabriel also highlighted “much good practice”, she found board members could only provide limited examples of how governor input affected strategic thinking and the council of governors felt undervalued, believing its skills, insights and experiences were underused.

Governors felt they were receiving information after a decision had been made, rather than influencing board decisions, the report said. The papers governors received for their council meeting were also felt to be “too lengthy, too full of graphs without an adequate narrative to describe what they meant”. 

On the other hand, a large number of questions in succession from governors during meetings meant non-executives “were left feeling cross-examined rather than benefiting from governor insight,” and questioning often concentrated on operational issues, rather than strategic direction.

Ms Gabriel suggested board members and governors needed to spend more time together with improved communications and clarification on specific responsibilities and a “refresh” of accountabilities, including how governors interacted with members.

The trust was rated “good” by the Care Quality Commission earlier this year. The CQC’s inspectors commented on the “informed and confident” challenge by non-executive directors and the strengthened operational focus from the board.

However, the trust has struggled to meet demands on some of its services – especially around child and adolescent mental health services – and dropped plans to be the lead organisation for a CAMHS new model of care pilot late last year. In June, HSJ reported Surrey County Council was to withdraw from an agreement to provide integrated community mental health services with SABP.

Commenting on Ms Gabriel’s report, Dr McPherson said: “The review helped give us a fresh perspective on both what was working well and where there were gaps and offered a mixture of suggestions and practical ideas we could try out. It was conducted very much in the spirit of building on what we were already doing to work more collaboratively and to develop the role of governors in our organisation.”

He said the board and governors had reviewed the recommendations and had introduced changes, including:

  • Informal meetings between governors and non-executive directors now focussing on live issues, after concerns they had become too structured;
  • Governors for people with learning disabilities presenting on their experiences with the director of learning disability services, with plans to use this approach with other governors and carers;
  • The trust reviewing the format and content of meetings to introduce more topics of interest to governors; and
  • The trust developing a governor-led newsletter to share with foundation trust members.

The HSJ Transforming Mental Health Summit, taking place at the Hilton Leeds from 28-29 November, unites 120+ senior figures from across the NHS, local authority and wider mental health service delivery landscape to discuss how to realise the visions of the NHS long-term plan and ensure successful local implementation of national priorities. Held under the Chatham House Rule, attendees will quiz Paul Farmer and other national figures on general policy direction and co-develop solutions to their local challenges with NHS and local government colleagues from across the country. The Summit is free to attend for senior NHS and public sector figures – register your interest here for this free to attend forum on our website: https://mentalhealth.hsj.co.uk/register-2019