Andy Burnham's ambitious plan to devolve more power to regions and communities across the UK has hit a major snag in its application to the National Health Service (NHS). Critics argue that the current health bill, if passed into law in its present form, would undermine the very principle of devolution by restricting local decision-making within the NHS.
NHS foundation trusts currently have a vital layer of local accountability and oversight through councils of governors. These councils are made up of unpaid volunteers, democratically elected from the public and staff, and operate independently of NHS management. Crucially, they hold the power to appoint trust chairs, ensuring that local voices have a say in how their local services are run.
However, the proposed health bill seeks to remove this statutory requirement. Under these new proposals, local trusts would gain greater autonomy in internal governance, but the appointment of trust chairs would shift from local councils to a more centralised process controlled from Whitehall. This move has been met with opposition from Daughne Taylor, Chair of the National Lead Governors Association, who argues that all trusts should maintain a statutory council of governors.
Taylor suggests that these bodies could transition to a locally selected model rather than an elected one, potentially making the system more cost-effective. What's crucial is that these councils must remain independent of NHS management, continue to represent both public and staff interests, retain the power to appoint trust chairs, and have a statutory right to challenge decisions at board meetings.
Supporters of local oversight argue that robust governance is essential for preventing local NHS issues from escalating into crises. By giving local voices a say in how their services are run, we can safeguard patient care and ensure service quality remains high.