Behold, I bring you good tidings of great joy which shall be to all people – not just staff

Who says consultations don’t make a difference?  Going through the detail of Wednesday’s announcement about the way forward on the NHS reforms in England, reveals that Government has thought better of what was always a daft idea in the Liberating the NHS white paper about the regulation of healthcare providers. Namely, having some Foundation Trusts with employee-only Membership.

This was wrongheaded on several levels:  1) it would have turned the FT into a staff owned mutual which is contrary to the FT’s authorisation; 2) it would have excluded the community from having a stake and a voice as Members and Governors in what is after all legally defined as a “community benefit corporation” and 3) perhaps more far fetched but not beyond the pale, it would have created an organisation whose valuable  assets  – transferred without cost from the public ledger – could be vulnerable to outside disposal if  “demutualisation” occurred.  In other words “privatisation”.  And Mr Lansley stressed again  in front of the Health Select Committee this week that he does not intend to privatise FTs.

This isn’t about John Lewis

It needs stressing that none of this has anything to do with the “John Lewis model” of employee-owned mutuals. They didn’t start out being handed valuable public assets to get their business going and they are not established legally for the benefit of the community. Significant differences from NHS employee-owned businesses.  Sure, we would like some of their characteristics about customer responsiveness and morale in the public services, but that does not mean aping them uncritically.

MAC champions the owners – the Members of the Foundation Trust

MAC always opposed the idea of staff-only FT membership  because it fudged the ownership question: who are the owners of a Foundation Trust? The answer  to this question is the owners are the citizens, patients and staff members who sign up (register) as Members and acquire voting rights to elect Governors who represent their interests to the Board and management.  Guidance setting up FTs is very clear: “The members of an NHS Foundation Trust will, collectively, be its legal owners. This is a real and not a paper exercise in social ownership. As such the rights of membership will therefore confer some limited but real legal responsibilities.”

Mutuality varies

Mutuality models vary on the ownership question.  A GP co-op as an employee-owned mutual is one thing; a Foundation Trust controlled solely by the people whose livelihoods depend on it is several magnitudes different and not in the public interest.   In making this proposal in Liberating the NHS, Mr Lansley failed to distinguish between types of mutal ownership and that would have had big implications.  But now we see that government has had second thoughts. We welcome that.

Second thoughts

In the response to White paper laying out the legislative framework and next steps, we find this  volte face:

6.17 Regulating healthcare providers discussed the prospect of enabling FTs to have employee-only memberships. Not many respondents commented on this proposal but, with some exceptions, those that did were generally not supportive. The CQC said that staff-only models without patient and public involvement could be at odds with public accountability and should be avoided, while the BMA thought they would do nothing to improve patient care. The Government has considered these concerns and concluded that staff-only membership would not be compatible with the foundation trust model.

Strengthening accountability through Governors

This common sense decision is another reason why we welcomed Wednesday’s announcements of strengthened powers for the FT Governors – the Members’ elected representatives – to hold Boards of Directors to account.

Could the change of heart also have something to do with still fresh memories of the scandals at Stafford Hospital, part of a shiny new Foundation Trust?

The Moore Adamson Craig Partnership supports user and public participation,  trains lay representatives and develops responsive  health, care and education organisations.  We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing.  Feel free to contact us to discuss the opportunities.


  1. Andrew Craig says

    Nice to see Paul Corrigan’s blog making this same point about abandoning the silly position of employee-only FT membership. Here’s his take on it: Next steps persists in saying that the Government wants to create “the largest and most vibrant social enterprise sector in the world” and it would appear that most of the way in which this will happen is through FT providers. The Government have dropped the idea of creating FTs that are wholly owned by their employees because they quite rightly recognise that these are very large public assets. They do want to build on existing governance with many more members. They chose to do this by further empowering governors who are elected by members.

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