Notes from the field of public involvement

Friday, 18 February 2005

Getting to grips with Governance

One of the increasingly important strands of public debate around public sector organisations and the health service in particular is best practice in governance. There is a great need for clarity and understanding – what is the answer to the question “When do I have to carry the can and for what?” Practising “good governance” in Foundation Trusts is the obvious preventative measure to avoid Monitor’s wrath, but finding out what it is can be less than straightforward. Here are some gleanings we have found recently to help get to grips with good governance.

Who are we anyway?
Monitor’s site has a clear, simple and recent (Jan 05) statement in their Publication Scheme of the legal definition of a Foundation Trust and Board of Governors. This is useful as some reports of what FTs are seem to be blurring at the edges. This is the true gospel.


"NHS foundation trusts are a new type of NHS body. They are legally independent organisations called public benefit corporations, whose principal purpose is the provision of goods and services for the NHS in England. They continue to deliver NHS services to NHS patients. Those services continue to be commissioned and paid for by locally based NHS primary care trusts (PCTs)."
"The Board of Governors is responsible for representing the interests of the members and partner organisations from the local health economy in the governance of the NHS foundation trust."

Audit Matters
On Monitor’s site there is guidance for Foundation Trust Governors carrying out their statutory role in appointing the FT’s external auditor. This is an example of what the statutory power really means . In fact it means relatively little, as the Governors are asked to approve (or not –but if not, on what grounds can they refuse?) the recommendation of the Board’s Audit Committee

Guide for Governors: Audit Code for NHSFTs (October 04)

The arrangements for internal audit of Foundation Trusts seem to be the same as for other NHS Trusts. It is a service to the Chief Executive and the Board. Read how it works in a London Trust here: http://www.whittington.nhs.uk/Documents/Internal%20Audit%20Service%20TOR_1836.pdf

and see how the same Trust’s Audit Committee works here: http://www.whittington.nhs.uk/Documents/Audit%20Committee%20TOR_1837.pdf

Freedom of Information Act Requests
One of the things the Board will have to have a policy on is handling requests under the Freedom of Information Act (FOI). Monitor has a guidance document on this too:

Information Data Requests - Guidance for NHS Foundation Trusts and Sponsors December 2004

What about the Constitution?
Foundation Trust Constitutions – they all work to a model, but some FTs have used this to give Governors additional responsibilities. The principle is that the Governors in any FT cannot have less power than the model constitution allows, but they can have more if their FT has written this in to their particular constitution and Monitor has agreed it. The model document and the explanatory notes which came from the Dept of Health say very little about the Chief Executive and the relationships of that role with the Chair and Board (as compared with pages and pages about constituencies and elections for Governors). The model constitution also clarifies points about the Audit Committee and the Remuneration Committee membership and powers.

We have posed the question "Who 'owns' the Constitution in a Foundation Trust?" and have come up with this answer: "There is shared ownership of the FT Constitution. Monitor is its external guardian and the Governors are its internal custodians on behalf of the Membership. The Board of Directors is charged with putting it into practice and complying with it as part of their responsibility for the whole of the FT’s business".

Don’t forget the NEDs
Take a look at the autumn 04 NEDs Bulletin from the Appointments Commission where you will see a report of what Bill Moyes of Monitor thinks the role of Chairs and NEDs in FTs is (see seven bullet points on page 8). Enlightening. You can get this as a PDF: http://www.appointments.org.uk/docs/bulletin0411.pdf

And finally..

"Tout comprendre, c’est tout pardonner" Forget the attribution and discuss with particular reference to the management of the health service. Confer as much as you like. Examiners will collect the papers and results will be available in May 2005. All contributions gratefully received.

Andrew Craig | Send feedback