Trust the Foundation?

Ah, back in business at last.

On Monday evening, as a member of the James Paget University Hospital Foundation Trust, I attended what they advertised as the ‘AGM.’ The number in attendance, without taking an exact census, was roughly 60 people. The overall majority of these were either NHS staff and representatives of one flavour or another or Governors and Directors of the Trust. Ordinary people - members of the general public who were not any of the above, were in a very substantial minority.

An ‘AGM’ in the true sense it wasn’t. Most of the evening was taken up by presentations of the Trusts considerable achievements - achievements they have every right to be extremely proud of:

• No hospital acquired MRSI since March 2008 and a very low C Difficile count and accreditation as a national exemplar for infection control;


• leading edge developments in bowel cancer screening;


• a new hyperbaric chamber;


• improvements to the paediatric allergy service;


• great progress towards the 18 week waiting list targets;


• good developments in coronary and stroke services.

What there wasn’t was any sign of speaking to the Annual Report and Accounts and taking comments, questions or motions related to these (which, in my experience is what AGMs are supposed to do). I was told these were available at the meeting but they were so conspicuous by their absence that the Chair was obliged to give me his copy (after carefully checking it wasn’t annotated).

In particular, considering that the Monitor (the Foundation Trust Regulatory body) Code of Governance says:

G.1. Main Principle.
The board of directors should appropriately consult and involve members, patients, clients and the local community. Notwithstanding the complementary role of the governors in this consultation, the board of directors as a whole has responsibility for ensuring that satisfactory dialogue with its stakeholders tales place.

there was no reference at all to the members’ meeting in March of this year (the first one since the award of foundation status over two years ago). That members’ meeting set members’ objectives which were carefully recorded by immediate direct transcription and, if the Trust is concerned with anything other than ticking boxes, those objectives and how they are being addressed should have been a central part of the ‘AGM.’ There was a short questions-from-the-floor session at the end of the ‘AGM’ and I did ask a question about this which was dismissed somewhat high handedly by the Chair (with assistance from the ex-chair of the Trust PPI Forum, now a Core Group Norfolk LINks member and a Governor for the Public Constituency of the Trust). I also asked about the absence of any input from PALS - to me a centrally important element in patient choice and patient involvement. That was dismissed with equal distain.

There are, in my opinion, three important issues here. The first is:

• is the Trust practising a degree of tokenism in its approach to Patient and Public Involvement ?

• My main concerns at the March members’ meeting was (and remains) that the Trust has no dedicated mental health representation on its Board of Directors or its Governors Council. In the light of national recognition of the neglect of the physical needs of people with mental health problems, I think this is a scandal.

• is real independence possible where a person who is Core LINks member is also a serving Governor of a Trust monitored by those LINks. I’m wrestling with this one and currently agnostic - the PPI forums barred this by Ministerial Regulation but LINks are left to determine if there could be possible conflicts of interest there. However, there are subtle dynamic pressures to conform to the group and power and status rewards invariably involved.

My third question (I felt a bit of a paraiah with these challenges in the middle of all the eulogy) was to the bowel cancer Consultant. I’m a ten year+ survivor of bowel cancer and have to have a periodic follow-up colonoscopy. The Consultant, in his presentation, presented figures for clinical accidents in the procedures: 17 accidents, 1 perforation and one death. I asked what period of time these were over and explained that after my last colonoscopy in 2005, I had to be admitted (at 1am) as an emergency to the JPH with a perforated bowel. He didn’t tell me the time span of his figures but he did say they had kept clinical records and there had been year on year improvements. But shouldn’t these statistics, especially in the light of widespread bowel screening, be freely available in the public domain - or are they keeping them under wraps in case they frighten people?

Lastly, the Trust Annual Report says (page 35) “The Trust aims to comply with all Monitor guidance where possible...With the exception of provision C.2.1.” This says:

C.2.1. Approval by the board of governors of the appointment of a chief executive should be a subject of the first general meeting after the appointment by a committee of the chairman and non-executive directors. Re-appointment by the non-executive directors followed by re-approval by the board of governors thereafter should be made at intervals of no more than five years. All other executive directors should be appointed by a committee of the chief executive, the chairman and non-executive directors and subject to re-appointment at intervals of no more than five years.

Why?