Foundation trusts are operating a “closed door” culture that excludes staff and patients from important decisions, Royal College of Nursing research warns.
RCN chief executive and general secretary Peter Carter said engaging clinicians more would help trusts make better decisions for patients, for example on service reconfigurations.
He said: “Today’s report contains some alarming findings that suggest foundation trusts are not living up to their promise to provide an opportunity to engage staff and patients in a meaningful way.”
The first foundation trusts were set up in 2004 with the aim of encouraging local accountability and autonomy.
The foundation model gave staff and the public the chance to become members or stand as governors, enabling them to vote on key decisions.
The RCN report, New Foundations: the future of NHS Trust Providers, backs up findings published in Nursing Times’ sister magazine HSJ revealing few staff are actively involved in decision-making at foundations.
The report found that nearly half of nurses who work at foundation trusts did not feel that being a member of a foundation trusts made any difference to how it was run.
Less than half reported that decisions reached at board meetings were communicated back to members and staff.
Dr Carter said this was impacting on the care being provided to patients.
He said: “Too many [service reconfiguration] decisions are made without …clinical staff. Too often they’re made for financial considerations as opposed to clinical considerations.”
RCN head of policy Howard Catton said he was “very confident” that staff at Mid Staffordshire Foundation Trust would have called for impact assessment on the likely effects of cutting 300 nursing posts, if they had been given a voice.
At last week’s UNISON conference, health secretary Andy Burnham called on foundation trusts to meet in public.
NHS Confederation foundation trust network director Sue Slipman responded today: “The network does not believe that the key question around openness and accountability is whether or not corporate board meetings are held in public - the RCN agrees that there will always be a closed part of the meeting, for example to discuss commercially sensitive issues or individual staff.
“It is whether stakeholders, and in particular, governors, have all the information they need to judge the performance of the corporate board and hold it to account.
“The RCN’s on-line snapshot survey does highlight the scope for staff, including nurses, to become more actively engaged in their foundation trust and we look forward to working with the RCN to bring this about.”