Tuesday 9 June 2009

Secrecy and Accountability in the NHS

One of the things I do in my UNISON role is attend Yeovil Hospital's Joint Committee for Negotiation and Consultation every couple of months. This morning was one such meeting, the union reps from four different unions (UNISON, Unite, Royal College of Nursing and the Royal College of Midwives) meeting with the Human Resources team and the Chief Exec.

I took the opportunity of asking about Trust openness. NHS Trust Board meetings were by law open to the public, NHS Foundation Trusts are under no such obligation and as soon as Yeovil got Foundation Trust status in 2006, it decided to hold all Board meetings in secret. That's always rankled with me because I feel that an organisation without accountability descends into corruption sooner or later. That seems to me particularly the case with Monitor's very loose regulation of Foundation Trusts. I've even been forced into the use of Freedom of Information requests to Yeovil Hospital in order to get information that they should be sharing with the unions as a matter of course.

The Mid Staffordshire affair has put the issue of corporate governance in the NHS right back in centre stage. Mid Staffs, like Yeovil, held it's Board meetings in secret and before he left the Department of Health Ben Bradshaw called on all Boards to be open. With a newish board, it was worth having another go at it.

Gavin Boyle, Yeovil Hospital's Chief Exec had a view that I've heard from other directors previously, that the non-execs challenge better and discussions are more open than if there's reporters at the board meeting eager for a juicy hint of dissent. So according to Mr Boyle, boards that meet in public actually decide everything in secret before having a stage managed board meeting.

I have some sympathy for that view, though I do think Mr Boyle overestimates the inquisitiveness of the local press he's got to deal with in Somerset. But my central point holds, has there been an organisation funded with public funds that has excluded that public from knowledge of decision making and yet failed to eventually turn to corruption?

I think that, the local press not withstanding, Directors and non-execs need to trust the public with the knowledge that yes, the Trust will make mistakes and the Trust will learn from them.
We're moving into age with multiple sources of information. People are starting to expect to find everything on the internet and the organisations that stay closed will start to lose public trust.

If I was Chief Exec, I would bite the bullet and not only open the Board meetings up, but record them and put them on our website. There might be some minor bad press, but that would be outweighed by the positive effects of showing we have nothing to hide. That goes for Board of Governors meetings too, they are held in public already, but who among Foundation Trust members can give up a working day to attend a meeting. If we're asking members of the public to vote for Public Governors, then we need to know what those Governors do.

Yeovil's a good hospital with a very good Board, by opening up they can be seen to do the right thing too.

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