Foundation trusts grapple with ser vice users’ part in governance role

Service users have lobbied for different approaches to being involved in trusts’ governance boards. Gordon Carson reports

The extension of foundation trust status to NHS mental health bodies has created a dilemma about how best to involve service users.

As part of trusts’ governance arrangements, patients and their carers, along with staff and members of the public, can stand for election to boards of governors. Trusts must set up separate membership constituencies for the public and staff but it is optional to have a specific group for service users.

There are concerns that service users could be marginalised by “not in our backyard”-type arguments if they are only included in trusts’ public constituency. But separate constituencies for mental health service users could stigmatise them.

The first three mental health bodies to achieve foundation status have proceeded in different ways.

One in four of South Essex Partnership NHS Foundation Trust’s 10,000 members are service users, but there is no separate constituency for them. Chief executive Patrick Geoghegan explains the decision: “Service users said to us ‘we are part of the public, why do you want to treat us differently?’.”

South Staffordshire Healthcare NHS Trust has taken a similar approach by setting up a joint membership constituency for the public and service users.

Chief executive Mike Cooke says 13.9 per cent of its 9,300 members have declared themselves to be service users. He says South Staffordshire opted for a joint constituency because this sent out an “anti-stigma message”.

He admits to being worried that under this format more “pushy” members of the public might have beaten service users in elections to the trust’s membership council. But his fears were unfounded: 12 of the 40 members are service users or full-time carers. Also, the trust’s constituency of partner organisations includes representatives from bodies such as People First, a self-advocacy group run by people with learning difficulties.

Oxleas NHS Trust, which serves south east London, has set up a specific service user group. Ann Rozier, head of governance, says service users “overwhelmingly” supported this model during a consultation. Oxleas has had a user council for five years and foundation status will help the trust to mature, she says.

Its board of governors includes 12 elected service users or carers, 12 members of the public and six staff, plus 17 appointed governors. Rozier says service users are not intimidated by the other groups on the board. For example, the board’s deputy chair is service user Christopher Stables. He says the separate service user constituency shows people with mental health problems are incorporated into the trust.

“One of the problems with mental health problems is that most of the people who suffer from them have lost confidence,” he says. “Seeing other people with similar problems to their own who have taken the plunge, stimulates that confidence.”

Charities say individual trusts will know best how to shape their governance arrangements.

Moira Fraser, head of policy at the Mental Health Foundation, says: “The structure of the group is not the issue, the issue is that the trust makes every effort to involve people who use its services at every stage.”

Whatever their structure, the first trusts with foundation status say it will help them to provide better services and get closer to service users.

 Trust Members   %Who are service users Separate user group 
 South Essex




 South Staffordshire








Additional reading
More on foundation trusts

Further information
South Essex Partnership NHS Foundation Trust
South Staffordshire Healthcare NHS Trust
Oxleas NHS Trust
Mental Health Foundation

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