My Research into "How Democratic Are NHS Foundation Trusts?"

Here is the "abstract" or summary of the research that I conducted in 2009-2010 as part of the Masters in Global Politics that I completed at the University of Southampton. I interviewed around sixty people.

National Health Service (NHS) Foundation Trusts (FTs) were brought in to allow a degree of autonomy from centralised Whitehall control, along with a degree of local governance, modelled on traditions of co-operatives and mutuals. 

This research assesses how democratic the arrangements for FT governance are. Interview and questionnaire responses, from individuals selected from politically engaged groups, were assessed against an analytical framework of democracy. 

Content analysis software was written specifically to aid the categorisation of the interview and questionnaire texts against this framework. 

Overall, comparing positive evidence against negative evidence, respondents felt that democracy was generally lacking in FTs. Also lacking were important aspects of democracy, including accountability, popular control, inclusion, legitimacy and considered judgement. There was insufficient evidence to be conclusive about transparency and efficiency. Assessment of local involvement was positive and generated significant support for FTs. Local autonomy also motivated significant support for FTs. 

Taken together, this evidence indicates an encouraging appetite for local involvement and autonomy in FTs in theory, but the practical implementation of FTs has not met theoretical expectations. This evidence is backed up by the theoretical literature, and by predictions made by commentators when FTs were new. 

Lessons can be learnt from the literature, from the evidence presented herein, as well as lessons from before the NHS existed. Finally, suggestions for future policy and research are made.

If you would like to know more about the research, please get in touch.

Following the research, I made a number of recommendations, including on policy. I am campaigning on those recommendations, and on NHS governance.

Let me know your experiences of how foundation trusts are run. I would also be interested in hearing from other researchers, particularly in the light of failings of governance, such as at Mid-Staffs and Southern Health.