I worked at St Thomas' Hospital and King's College London for 39 years as a university lecturer in virology. St Thomas' is in a wonderful location, as it is right on the River Thames. After retiring in 2004 I heard about foundation trust governors and felt it was a good way to stay involved, and to give something back. I was elected as a public governor at Guys and St Thomas' NHS Foundation Trust (GSTT) in 2007. It was a very new experience for me, making decisions as a whole council and being a critical friend of the trust when holding the non-executive directors to account.
Having finished my six-year term at GSTT, an acute trust, I was elected as a public governor at South London and Maudsley NHS Foundation Trust (SLaM), a mental health trust, in 2014. I have been lead governor since 2017, but plan to step down this November. Being a governor at SLaM is very different from GSTT. It is a large trust which provides services on about 200 different sites over four London boroughs, with some additional services in Greenwich and Wandsworth. SLaM provides a lot of national specialised services, for example caring for those with eating disorders and a mother and baby unit.
Perhaps one of the challenges of being a governor is that we tend to focus on the areas of the trust that we think need improvement, but don't always celebrate what is going well.Lead Governor
Perhaps one of the challenges of being a governor is that we tend to focus on the areas of the trust that we think need improvement, but don't always celebrate what is going well. In the past our council of governors were concerned about what they perceived to be a lack of focus on community care, and a feeling that attention had been concentrated on inpatient care. However, more recently a lot of effort has been going into improving all community services. Another problem had been the large number of patients having to go to "out of area" beds, away from their families and loved ones. The trust made an ambition to reduce these out of area placements within a year, ensuring care closer to home and in the right environment. As lead governor I voiced my concerns to the board on whether this would be feasible. However, by working together to improve delivery for patients, and a focus on "right care, right time, right place" SLaM had no patients in non-SLaM beds by mid-March, which they can be very proud of.
It can be quite a struggle for a council to get to know each other, and to build trust and relationships, as most of our meetings are relatively formal and only take place once or twice per month.Lead Governor
This is where I feel governors, particularly service user governors, can have an impact. However, this is not without challenges – for example, some governors may be prevented from lending their voice when they need to step back from meetings to look after their own wellbeing. Equally challenging, as volunteers, there is a limit to the amount of time we are able to commit. I hope that as lead governor I have encouraged my council to work together to make a positive contribution. It can be quite a struggle for a council to get to know each other, and to build trust and relationships, as most of our meetings are relatively formal and only take place once or twice per month. It is a particularly difficult time as I write this in April, as coronavirus (COVID-19) has stopped our meetings, at least in person. Our plans for external engagement have also been put on hold.
One of the Trust's big drives is to make sure we are enabling equal opportunities and including better representation of individuals with black, asian and minority ethnicity on our council, and in recruitment processes. It can also be challenging to effectively engage with our local communities. Early in my term as governor we did a series of meetings in all four boroughs, but attendance was poor in three of them. We have tried other approaches, including using the contacts our governors already have in the community, in order to represent the population the trust serves. In the future we will work with SLaM external engagement staff in order to contribute to meetings that they organise.
As governors we were horrified to find how underfunded our mental health services and facilities are. We have lobbied local MPs to make the case for more funding, and although we have seen an increase in funding this year, we feel that we are still a long way off the parity of services which is supposed to exist between mental and physical health services. There is also a wider issue about understanding how mental health services work, with staff having to travel across large geographical areas to multiple sites and some patients being admitted for several weeks. Compared to a busy acute hospital, the main hospital building of a mental health trust can seem much quieter, as the majority of patients are seen in the community.
Going forward there are a few key areas within the health and care system I feel need more focus. Working as a governor has allowed me to understand the importance of foundation trust membership, and the public voice, in local NHS services. The merging of clinical commissioning groups (CCGs) in our area has apparently reduced the lay membership and this is a cause of concern. It would be good to consider whether there could be some sort of public oversight of the merged CCGs. The development of more integrated care systems is interesting, as it provides opportunities for the various services to work together. Perhaps there is an opportunity here for community services to work more closely with mental health services.
Having been a foundation trust governor for 12 years, I am going to miss my fellow governors and the many dedicated members of staff, when I stand down.