Organizational Form as a Mechanism to Involve Staff, Public and Users in Public Services: A Study of the Governance of NHS Foundation Trusts

Allen, Pauline; Townsend, Jean; Dempster, Paul; Wright, John; Hutchings, Andrew; Keen, Justin

doi:10.1111/j.1467-9515.2011.00820.x

Cited by 18 publications

(28 citation statements)

References 22 publications

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“…In practice, research has shown that this model has delivered little in the way of local accountability. 34 The GB model adopted by CCGs is supposed to embody an ideal of accountability to members; it remains to be seen if this remains the most effective governance model as the commissioning landscape changes.…”

Section: Discussionmentioning

confidence: 99%

Complexity in the new NHS: longitudinal case studies of CCGs in England

et al. 2016

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ObjectiveThe reform in the English National Health Services (NHS) under the Health and Social Care Act 2012 is unlike previous NHS reorganisations. The establishment of clinical commissioning groups (CCGs) was intended to be ‘bottom up’ with no central blueprint. This paper sets out to offer evidence about how this process has played out in practice and examines the implications of the complexity and variation which emerged.DesignDetailed case studies in CCGs across England, using interviews, observation and documentary analysis. Using realist framework, we unpacked the complexity of CCG structures.Setting/participantsIn phase 1 of the study (January 2011 to September 2012), we conducted 96 interviews, 439 h of observation in a wide variety of meetings, 2 online surveys and 38 follow-up telephone interviews. In phase 2 (April 2013 to March 2015), we conducted 42 interviews with general practitioners (GPs) and managers and observation of 48 different types of meetings.ResultsOur study has highlighted the complexity inherent in CCGs, arising out of the relatively permissive environment in which they developed. Not only are they very different from one another in size, but also in structure, functions between different bodies and the roles played by GPs.ConclusionsThe complexity and lack of uniformity of CCGs is important as it makes it difficult for those who must engage with CCGs to know who to approach at what level. This is of increasing importance as CCGs are moving towards greater integration across health and social care. Our study also suggests that there is little consensus as to what being a ‘membership’ organisation means and how it should operate. The lack of uniformity in CCG structure and lack of clarity over the meaning of ‘membership’ raises questions over accountability, which becomes of greater importance as CCG is taking over responsibility for primary care co-commissioning.

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Section: Discussionmentioning

confidence: 99%

Complexity in the new NHS: longitudinal case studies of CCGs in England

et al. 2016

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“…Governors have been lauded as potentially able to understand and represent the experiences of patients and staff (Lowe-Lauri, 2008;Ham and Hunt, 2008), as well as providing an alternative source of service knowledge and expertise (Allen et al, 2012). Furthermore, Governors have the potential to fill in key intelligence gaps not picked up by external healthcare regulators or by existing internal governance mechanisms often characterised by continuous restructuring and staff turnover.…”

Section: Meta Regulation Meets Deliberation: Situating the Governor Wmentioning

confidence: 99%

“…In addition, FT hospitals contain Governors comprised of people elected from the local community and staff representatives. They also include a Council of Governors intended to provide a forum to oversee and engage with the executive board across a range of hospital governance issues (Ocloo et al, 2014;Allen et al 2012). The Council has legal statutory duties for appointing or removal of the chair and other non-executive directors, appointment of the trust's auditor, and receipt of annual accounts and reports ( Table 1).…”

Section: Governing Nhs Foundation Hospital Trustsmentioning

confidence: 99%

Meta-regulation meets Deliberation: Situating the Governor within NHS Foundation Trust Hospitals

Millar¹,

Freeman

Mannion³

et al. 2018

J. Soc. Pol.

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NHS Foundation Trust (FT) hospitals in England have complex internal governance arrangements. They may be considered to exhibit meta-regulatory characteristics to the extent that governors are able to promote deliberative values and steer internal governance processes towards wider regulatory goals. Yet, while recent studies of NHS FT hospital governance have explored FT governors and examined FT hospital boards to consider executive oversight, there is currently no detailed investigation of interactions between these two groups. Drawing on observational and interview data from four case-study sites, we trace interactions between the actors involved; explore their understandings of events; and consider the extent to which the proposed benefits of meta-regulation were realised in practice. Findings show that while governors provided both a conscience and contribution to internal and external governance arrangements, the meta-regulatory role was largely symbolic and limited to compliance and legitimation of executive actions. Thus while the meta-regulatory ‘architecture’ for governor involvement may be considered effective, the soft intelligence gleaned and operationalised may be obscured by ‘hard’ performance metrics which dominate resource-allocation processes and priority-setting. Governors were involved in practices that symbolised deliberative involvement but resulted in further opportunities for legitimising executive decisions.

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“…FTs were introduced in the context of an evolving and diverse set of mechanisms for patient and public involvement reflecting very different discourses underpinning the involvement of service users and citizens across the public sector as a whole and the NHS in particular . The lack of an overarching framework, indicating how involvement mechanisms relate and interact, has created a confused and complex landscape for service users and staff to negotiate . In principle, FTs’ governing structures provide valuable opportunities for service users to be involved in senior‐level decision making.…”

Section: Introductionmentioning

confidence: 99%

“…In principle, FTs’ governing structures provide valuable opportunities for service users to be involved in senior‐level decision making. However, evidence from the limited empirical research into CoGs, all of which focus on acute rather than mental health trusts, highlights that the scope for influence is constrained by the lack of clarity and agreement around who lay governors represent, and how they communicate with their constituencies. This, alongside confusion about or ignorance of other mechanisms for involvement, may result in uncertainty about the scope of power and influence held by CoGs.…”

Section: Introductionmentioning

confidence: 99%

Service user governors in mental health foundation trusts: accountability or business as usual?

MacDonald

Barnes

Crawford

et al. 2014

Health Expectations

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Context National Health Foundation Trusts present opportunities for individual mental health service users to be active in the governance of trusts. This is one of a range of mechanisms for patient and public involvement and one which promotes an individual rather than collective approach to involvement.Objective Within the context of a broader study of the impact of service user involvement in mental health services, the objective of this article was to explore the experience of service user governors in foundation trusts and their capacity to hold boards to account.Design, setting and participants The Council of Governors in three foundation trusts were observed for a year. Focus groups with service user governors were undertaken in each trust.Results Service users had different expectations and understandings of the role and approached it in different ways. Key themes that emerged concerned: the role of a governor, conduct and content of meetings, agenda setting, relationships and representation.Discussion and conclusions The experiences of mental health service user governors need to be understood within the complex environment of patient and public involvement in general and of mental health service user involvement in particular. The dislocation of the service user governor role from other forms of service user activity and involvement result in confusion about how notions of holding a trust to account and representation of other service users can be addressed within a boundaried institutional environment.

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Organizational Form as a Mechanism to Involve Staff, Public and Users in Public Services: A Study of the Governance of NHS Foundation Trusts

Cited by 18 publications

References 22 publications

Complexity in the new NHS: longitudinal case studies of CCGs in England

Complexity in the new NHS: longitudinal case studies of CCGs in England

Meta-regulation meets Deliberation: Situating the Governor within NHS Foundation Trust Hospitals

Service user governors in mental health foundation trusts: accountability or business as usual?

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