On March 14th I attended a Foundation Trust Governors’ Association (FTGA) conference in Westminster. For some reason the FTGA calls these conferences “development days”. The line-up of speakers was impressive, including Andy Burnham, Shadow Health Secretary, and Robert Francis QC, chairman of two enquiries into the serious failings of the Mid Staffordshire NHS Foundation Trust (FT).
Around 230 governors attended, but Andy Burnham didn’t show up.
Jamie Reed MP
Andy Burnham’s speech was read rather badly, I thought, by Jamie Reed MP. He complained that social care, health and mental health are three separate services, asserting that:
“A single point of contact…is unlikely to be on offer in a three-service model.”
So a future Labour government would bring in a top-down restructuring of the whole system of health and social care, creating a one-budget, one-service model.
Torbay (in Devon) is successfully doing this already, we were told. We weren’t told why yet another a top-down restructuring of the whole system is needed if a one-service model can be implemented locally.
He defended central planning by asserting that:
“Markets deliver fragmentation.”
The implication was that a new Labour government would reverse the New Labour government’s 2005 “any qualified provider” policy, flouting the 2004 EU directive on which it was based. This seemed to me unlikely.
Attempting to answer questions from governors, he became evasive, refusing to answer a question about the timetable for Labour’s proposed NHS and social services policy review and ignoring a question about decisions being made without consultation.
When one questioner referred to the 2005 book NHS plc about the privatization of healthcare under New Labour, he fell back on the feeble:
“That is being looked at.”
I thought this was a disappointingly party-political presentation by an MP who didn’t know enough about health and social care to get away with standing up in front of an audience of governors.
Tony Halsall, NHS Confederation
From the four “breakout” sessions on offer, I chose the one entitled:
“Your relationship with the board in times of trouble”
But the presenter changed the title to:
“We’re all in this together”
Tony Halsall is an associate director of the NHS Confederation, a kind of club whose members are NHS organisations like trusts, and which lobbies on behalf of its members despite being registered as a charity.
His overall message was hard to discern, and it seemed to drift in the face of questioning by governors. He seemed to regard crisis within an organisation as a kind of natural disaster, like an earthquake, that affects the board and governors equally, as if the board has no executive function at all and is just a group of bystanders.
He was keen to promote solidarity between governors and the board, insisting that:
“Building relationships between the people in the system is massively important.”
I pointed out that solidarity can easily meander towards groupthink of the kind seen in Mid Staffordshire. Other governors put the presenter right on other aspects of solidarity, pointing out that the most difficult part of governors’ relationship with boards is often:
“What are they not telling us?”
I thought he did make some good points about organisational crisis, which were that individuals can react differently and unpredictably when crisis hits, and that decision-making throughout the organisation can become paralysed. But although these were good points they lacked analysis, and the concept of shock-proofing an organisation by pushing real decision-making authority down to the front line was never mentioned.
Robert Francis QC, who was present in the audience, said he thought governors had:
“…this feeling of not knowing what the job is…”
While that may be true of many governors, it was certainly not evident from the governors who attended the session and gave Tony Halsall a hard time.
I thought this was a confused session by a confused presenter, but the discussion it provoked amongst governors was very interesting and valuable.
Days after the conference Tony Halsall was in the news when his salary arrangements were revealed: Hospital chief still paid £225,000 one year after leaving struggling trust
Lucy Hamer, CQC
In the lunch break I attended a drop-in session about the FTGA’s joint project with the Care Quality Commission (CQC). Ten FTs had been involved, 2gether was one of them, and I was personally involved in the project. Lucy Hamer was the CQC’s project lead.
A report of the project was published on the day of the conference: Working together: The Care Quality Commission and foundation trust councils of governors
I said I had originally been skeptical about the value of the project, but that it had already had spin-off benefits for 2gether’s council of governors in terms of knowing more about what’s going on in relation to CQC inspections and also the Mental Health Act.
Robert Francis QC
Robert Francis QC had chaired the Mid Staffordshire public enquiry that reported to parliament in February this year, and also the previous NHS enquiry that reported in February 2010.
I had heard him speak on TV before the House of Commons Health Select Committee, and I was not very impressed at the time. His presentation to the conference was therefore a big surprise to me — he was by far the best speaker of the day.
He described how, as Stafford hospital, when things were going badly wrong, staff were submitting:
“hundreds of incident reports”
He gave some harrowing examples of the lack of care some patients endured, saying:
“Anyone could stop that, you might think, but where was the system to stop it happening?”
He told governors that, in similar circumstances:
“It’s your job to do something about it.”
He pointed out that obstacles like confidentiality may be used to try and stop governors finding out what’s really going on, advising:
“Confidentiality…reject it every time.”
He also advised that governors should consider the substance of complaints about care in their trusts, not just the overall numbers.
After an excellent presentation, his answers to questions were to the point, including:
“The public don’t know what governors are.”
“Inspection is the only thing that’s been shown to work…”
“If it happened to a child at home the parents would be prosecuted; why not in an NHS hospital?”
Richard Douglas CB
A civil servant gave a tedious talk about finance. It’s not that finance is tedious, but the talk was.
A governor summed it up after asking a question about governors’ role in approving large transactions, which didn’t get a coherent reply:
“I was looking for something a bit more intelligent, but thank you.”
In the morning there had been a presentation on the FTGA’s research strategy, and at the end of the conference there was a very brief Annual General Meeting.
Overall, the conference was extremely interesting and stimulating. I have no hesitation in recommending the FTGA’s events to all governors. I also recommend their website and its interactive forums where governors can register to discuss issues that affect FTs.