Governing an FT — Part 1

A Greater SayThis post contains the draft of Part 1 of a four-part guide for new governors and prospective governors of NHS Foundation Trusts. Drafts of Parts 2 to 4 will follow at some future time. I’m posting the drafts here first to allow for comments and corrections. After a final revision I’ll post the whole thing as a single PDF. The guide is based on my own experiences and impressions of my first two years as a governor.

Governing an NHS Foundation Trust: Part 1

This is a guide for new governors of NHS Foundation Trusts (FTs), based on my experiences in the first couple of years serving as a governor of the 2gether NHS Foundation Trust, Gloucestershire’s and Herefordshire’s mental health trust. I wrote this guide in 2013, trying to make it generally applicable to all FTs, not just 2gether, and not just to mental health trusts. It’s a personal view from an inexperienced governor, and it may contain things you disagree with, things that don’t apply to your trust, and things that are downright wrong.

About the author

I started to take an interest in public involvement in the NHS in 2010, joining Gloucestershire’s Local Involvement Network (LINk), which was funded by the County Council under a statutory duty to give local people a voice in the planning and delivery of healthcare and social care. In 2011 I was elected as one of the 2gether Trust’s two public governors for the Cotswold district, and in 2012 I was elected to the LINk’s Stewardship Board (the nearest thing it had to a board of directors).

My interest is in public engagement — how the public can have a say in healthcare and social care. Coincidentally, the Government published a white paper (a discussion paper) on the NHS in July 2010, around the same time I started to get involved, and according to the white paper the Government also had an interest in promoting public engagement. The paper is Equity and Excellence: Liberating the NHS.

As a record of the things I got involved in, I maintained an Internet blog called A Greater Say. It’s only a partial record, because I only write about some of the things that members of the public could have access to, not private meetings. The title of the blog is a quote from the Government white paper, which said:

We can foresee a better NHS that:

• Gives citizens a greater say in how the NHS is run

Skills and commitment

You don’t need any particular qualifications to become a governor, other than being a member of the trust together with whatever other requirements there are for you to be eligible in your constituency, such as living in a particular district.

If you intend to be effective, however, you do need to have already, or to develop, some skills. You also need to make a commitment of time far beyond the minimum requirement.

The skills you need are fairly commonplace. To be effective you are going to have to take an active part in long meetings, meet a lot of people, and make some sense of a huge amount of written information, some of it online on the Internet. If you have a disability that means you cannot easily do these things, the trust will almost certainly do everything it can to help you. If you have never done any of these things before, other governors will almost certainly be extremely supportive. But you will not be able to play an effective part without getting involved in all three of these key ways: formal meetings, talking to people, and written information, some of it online.

Some of the time commitment might overlap with other interests you have. For example, as an active LINk member I glanced at quite a lot of Department of Health announcements, and read some of them, just to keep up with what was going on, but I didn’t read many extra ones as a governor. Similarly, I tend to focus on areas of the Trust’s work that I already know something about, so that I don’t have to spend a lot of time educating myself about the basics in other areas.

The minimum commitment is usually to attend just a few committee meetings a year, but it is difficult to make a positive contribution if that’s all you do. As a very rough rule of thumb, I suggest doubling or trebling the number of meetings, and allowing the same amount of time again for research and preparation. So, if the minimum is four meetings a year I would plan for one meeting a month, and additional preparation time at least equal to the length of each meeting.

If you do not have access to the Internet, the trust will probably be helpful in providing printed versions of online documents, but some Internet access through your local library, family or friends, is still likely to be useful at times. It would be useful before starting out as a governor to establish how you might do this. An Internet access course might be valuable so that you have the basic skills to find your way around online and print documents.

Even if you are very short of time for the role you might still be able to be effective by having occasional bursts of governor activity, perhaps attending a series of related meetings and then disappearing for a while to do other things. It is better to attend one meeting well prepared to express your views, than to sit through two without contributing.

Example

Albert was not able to attend the last meeting of the council of governors or the last two meetings of the subcommittee that he’s a member of, but on the agenda for the next subcommittee meeting an item strikes him as odd. He remembers reading something about it in the trust’s last annual report, and so he checks to find the exact wording there.

At the subcommittee meeting, Albert finds he is the only person present who knows that the trust claimed the issue had been resolved more than a year ago. Quoting the annual report sparks off a discussion, and the subcommittee recommends bringing the matter to the next full council meeting.

The NHS and politics

Even before you are elected or appointed as a governor, your starting point for understanding the role should be an understanding of the NHS itself. A governor’s role is a very high-level role, and your understanding of the NHS needs to rise above the many different opinions that people have of it. As a governor you will represent people of all viewpoints in your constituency or stakeholder body.

Unfortunately for governors, the NHS is very political, and the range of viewpoints is very wide.
If you have strong political views yourself, reconciling your views with the facts might be the first obstacle that you have to overcome so that you can be an effective governor. For example, if you are strongly in favour of free markets in healthcare you will have to get used to the fact that the NHS is highly regulated and unionized. But if you are strongly against free markets in healthcare you will have to get used to the fact that the NHS has always depended on commercial contracts and market forces. The NHS is far more complex and diverse than ever comes across in political rhetoric.

Politics is more than just an external influence on the NHS. It’s a pervasive presence in the work of a governor, because many of the people you work with and represent will have strong political views of their own. In the worst cases, people you meet can sometimes feel it is appropriate to score political points when you are trying to have a serious discussion. If that kind of thing is going to make you cross or make you depressed, you might find it hard to be an effective governor.

Example

Beth is strongly opposed to the idea of competition in the NHS, so when she learns that her trust is considering bidding for a specialist contract in a neighbouring area she wants the council of governors to oppose the idea.
Talking to a member of the trust at an engagement event, she learns that the trust already sees many patients from the neighbouring area because specialist service there is so poor that many people choose not to use it. And talking to the council’s lead governor she realises that opposing a bid is not something a council of governors has the power to do. So, despite her personal views, she ends up speaking in support of the idea at the next council meeting.

Getting elected

Some governors are appointed by stakeholder bodies, and some are elected by members of the trust in their constituency. Getting elected can be easy, nor not, depending on how many other people in your constituency want the position. Sometimes governor positions lie vacant because no one wants to take on the work, but sometimes several people with impressive credentials compete for the same position.

In my case there was a position lying vacant and I contacted the Trust to find out how to apply. But by the time the next election came round there were two vacancies in my constituency and three candidates. I filled in a form including an election statement and a photograph, and just waited to see what might happen.
The personal statements of existing governors are sometimes published on the trust’s website. A good way to develop your own personal statement is to read them all and ask yourself who you would vote for, and why. Then write your own statement in a similar way. It’s a good idea to use the maximum number of words you are allowed, and a very bad idea to make yourself look foolish by going over the limit. Then have other people whose opinion you value read your statement and criticize it. Keep rewriting it until everyone is happy. If a lot of your acquaintances like your statement, a lot of voters will probably like it too.

In my statement I wrote a little about the relevant parts of my past, a little about the aspects of the Trust’s present work that most interest me, and a little about how I see the future. After the election I changed the wording slightly, but the version on the Trust’s website is still very similar to the version that got me elected.

Governors are elected for a standard three-year term of office. After three years you are eligible to be re-elected, according to the law. Some trusts have constitutions that limit the number of times you can be re-elected, despite what the law says, but no one has ever brought a legal challenge against an FT on the issue.

Example: My personal statement

The son of an NHS consultant psychiatrist at the former Hatton Hospital, Warwick, I am now a partner in a private psychotherapy practice. My family has suffered its share of mental illness, and I have been a Samaritans volunteer. I was once a teacher, and then for a time an education officer working with special schools, before becoming a collaborative computing strategist in the computer industry. My background provides a wide perspective on the Trust’s work, but I have a particular interest in:

  • Prevention and early treatment for young people
  • The value of promoting wellbeing and emotional resilience
  • How technology can make good, clear information widely available
  • Using evidence-based methods for the best outcomes
  • The central role of carers and support in the community
  • The importance of prompt access to effective psychotherapy
  • Skilled and compassionate care for mental decline in old age

At the time of writing big changes in the NHS are on the way. I am convinced they present some significant opportunities for the Trust, as well as some significant challenges. I was one of many who took an active part in the Government’s recent listening exercise, and I if elected would be delighted to be able to play a part in making public involvement in the Trust a positive force in all this.

Induction and training

Your FT might provide induction and training for governors. Mine provided just a one-to-one meeting with the Trust Secretary and some written information on governors’ statutory roles. I didn’t feel too bad about this because I felt I already knew a fair amount about the NHS and I am well used to meetings and committees.

Even if the Trust had provided a lot of training, I’m not sure how useful it would necessarily have been. Part of my reason for writing this guide is to explore what kind of obstacles there are to being an effective governor and what kind of ways there are to overcome the obstacles. Training is only one of the possible ways, and it can only address some of the obstacles. More nationally provided training is likely to be available for governors in future.

It can be helpful to set aside time for induction and training even if your trust doesn’t provide any, so that you can be self-induced (if that’s the right expression) and self-trained. You will probably be elected or appointed along with some other governors, and you will probably join a council where many experienced governors are already at work. It might be helpful to get together with the other new governors so that you can share information, if that is possible. Some trusts might operate a mentor scheme that pairs each new governor with a more experienced governor.

To introduce yourself to the work of the governors it can be very useful to attend meetings and events as an observer at first. I made a personal commitment to attend everything I possibly could in the first six months. In my Trust the policy was that any governor can attend any of the governors’ subcommittee meetings without having to be voted on to the subcommittee first, so I started turning up and introducing myself. There was a public Annual General Meeting where I turned up, too. The Board of Directors of the Trust also holds some of its meetings in public, and I attended a few of those. This meant I got a clear view of the Trust and of the governors’ work quite quickly, although for those six months I had to set aside other commitments in order to attend all those meetings.

Example

Colin is very interested how patients experience healthcare, but he has little interest in finance. On becoming a governor he was offered various opportunities to learn about the trust’s finances, Monitor’s role in financial regulation of FTs, and general principles of governance.

He mentioned to the Trust Secretary that he would be much more interested in attending a forthcoming one-day conference on the patient experience, and as a result of this conversation the trust agreed to pay for him to attend. On the day, he found that he was the only FT governor present. He was able to inform other delegates about the role of governors in FTs as well as learning a great deal himself and making some useful contacts.

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About Rod

Chairman of the Gloucestershire charity Suicide Crisis, Vice Chair of Relate Gloucestershire & Swindon, and an enthusiast for public involvement in the NHS.
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