Governance was a central theme of Robert Francis QC’s report on
the failings at Stafford Hospital. While Foundation Trust boards
and various regulators bore the brunt of the criticisms, the report
also has implications for Foundation Trust governors.
This article is part of our series of reports on the
implications of the Francis Report. For further information please
see our ‘Key Points Briefing’.
The report emphasises the role governors have to play in the NHS
quality agenda. Changes shortly coming into force under the Health
and Social Care Act 2012 grant additional powers to governors and
require FTs to provide information and training to their governors
to enable them to carry out their roles and responsibilities.
The focus of the report is on ways in which governors should use
their powers and resources to assist regulators’ oversight of
standards at FTs. A number of its recommendations will, if
adopted, see governors playing a proactive role as quality
watchdogs, forging links between the regulators, the FT and the
public at large.
If these recommendations are adopted, FTs will need to
reconsider their policies for interacting with governors and review
the information, training and reporting mechanisms they have in
place. Governors are to be a key source of information for
regulators, so FTs will need to consider how they can deal with any
concerns raised by governors to prevent escalation to
Governors as well as FTs may also need to consider how to deal
with repetitive or persistent complainants who do not accept the
findings of investigations or reviews. It can be all too easy to
dismiss such complaints but this is going to be increasingly more
difficult to achieve. Overall it needs to be met by a culture of
proactive openness about performance information, both to the
public and to the regulators.
Key recommendations relating to Foundation Trust
- The role of governors to be clarified – Monitor or the CQC
should publish guidance on the principles that governors should
follow, particularly focusing on the duties of governors to
communicate with the public and canvass public opinion on the
quality of services.
FTs may have to review their codes of conduct in light of any such
guidance. The report also recommends that governors and FT boards
should work together to develop a written policy setting out what
role governors have to play at the FT and how they are expected to
perform it. Such policies are to be subject to review by CQC.
- Governors should be more accountable, not just to the
membership who elects them but to the public at large – the report
calls for “regular and constructive contact between governors and
the public”. It is not at this stage clear how far FTs will be
expected to go to make governors accountable. Governor
accountability to the wider public could require the publication of
governors’ views and/or that the public should be given rights to
remove governors. If any of these changes are adopted, FTs will
need to consider practicable means by which governors can keep in
contact with the public at large. They will also need to ensure
that governors are sufficiently well-trained and informed about
practices and policies at the FT in order to (i) mitigate the risks
of damaging public statements being made by governors on behalf of
the trust, and (ii) ensure that any complaints or grievances
discovered are dealt with appropriately using the procedures that
the trust has in place for their investigation and resolution - not
needlessly ‘leap-frogged’ to board or regulator level.
- External training and support for governors – governors were
generally happy with the level of support internally and the
information given to them by the FT. The report nonetheless
recommends that greater external support should be provided.
Governors are being encouraged to act more independently of the FT
and the board, and to “expose and challenge” practices. FTs will
need to consider what, how and when they report to governors as a
means of satisfying them that standards are being complied with.
They will also need to ensure that there are robust procedures in
place for dealing with any concerns raised by governors.
- Regulators to forge close links with governors - the report
recommends greater use of ‘sounding board’ events by the CQC (who
the report would like to see take over supervision of foundation
trust governors). In addition the CQC should write to governors
inviting them to share any concerns regarding the FT.
The general picture is that CQC should increasingly use governors
as source of information about FTs. Information provided by
governors could impact on CQC registration and potentially negative
feedback will trigger unannounced inspections by the regulator. FTs
will need to ensure that information is provided to governors to
allay any concerns regarding service quality, and will need to do
so early if the CQC is to engage with governors. FTs may want to
consider how this can be dealt with during the election/appointment
and induction periods.
Seminar: The Mid Staffordshire Public Inquiry - essential
lessons for the health and social care sector
In the coming weeks Bevan Brittan is hosting a series of
seminars across its offices to consider the implications of the
Inquiry more fully. Following these we will issue more detailed
briefings on what the Inquiry's conclusions mean for different
players in the system.
The first round of our seminars in Bristol, Birmingham and
London are now fully booked; however we have added an extra
seminar date in London and a few places are still available -
please click on the link below for further information and to
register your interest for this event:
London: 14 March 2013.