Andy Burnham's flagship promise to devolve power to local communities may not apply to the NHS if the current health bill passes into law in its present form, according to Daughne Taylor, chair of the National Lead Governors Association.
Statutory councils of governors at risk
Currently, NHS foundation trusts have a statutory duty to have a council of governors. These unpaid volunteers are democratically elected from the public and staff, existing independent of NHS management to represent local views. They hold the vital power to appoint the chair of the trust. However, the current health bill will remove this requirement, allowing local trusts to effectively "mark their own homework" while trust chairs would be appointed centrally from Whitehall.
Taylor argues that this is the absolute antithesis of Burnham's devolution proposals. Instead of centralisation, all trusts should have a statutory council of governors. By moving to a locally selected model rather than an elected one, the system would be significantly cheaper to run. These bodies must remain independent of NHS management, represent the public and staff, be charged with appointing trust chairs, and hold a statutory right to speak "truth to power" at board meetings.
Safety measure against NHS disasters
Implementing such legislation is not just about democracy – it is a safety measure that would help prevent local NHS disasters before they are allowed to escalate, Taylor added.
John Marriott's call for federal UK
John Marriott from North Hykeham, Lincolnshire, responded to Burnham's plans by cautioning against devolving power to individuals rather than democratically accountable organisations. He warned that if Burnham seeks to create more elected mayors, he must ensure these individuals are up to the task. With current budgets of around £25m each, mayors can't do that much damage, but if real money and power are at play, Marriott advocates for nothing short of a federal United Kingdom, on the lines of Germany.
For this to work, the overwhelming economic power of England over Northern Ireland, Wales and Scotland needs to be diluted by creating six or seven English directly elected regional assemblies. This would leave the federal parliament in London responsible for a narrow portfolio, including foreign affairs, defence and economic development, with a senate drawing its members from the regions and nations of the UK to scrutinise legislation.
