Community Involvement in Hospital Governance in Britain: Evidence from before the National Health Service

Abstract

An important goal of policy in the British National Health Service (NHS) is to increase public involvement in health care governance. In the hospital sector this led in 2003 to the establishment of foundation trusts with "membership communities," which aim to give local citizens a say in management. This is not the first attempt to introduce greater community participation in the running of British hospitals. Prior to the inception of the NHS in 1948, the hospital contributory scheme movement provided ordinary members of the public with the opportunity to sit on hospital management boards. The article examines the nature and extent of this earlier experiment with local democracy in hospital governance. It argues that historical precedent is not particularly encouraging, either for the prospect of broadening popular participation or for making services more responsive to local needs. Although today's context is very different, the tendency for managerial and professional interests to dominate the policy arena is a feature of both periods.

The role of community representatives on health service committees: staff expectations vs. reality

“…Significantly more staff also thought representatives should represent the community than believe actually do this in practice raising the question of how realistic are staff expectations about the capacity of community representatives to always speak from a representative perspective. What constitutes representation and its importance has been a key feature of debate and discussion in the literature 7,12,16,20,34,46 . Some scholars have questioned the necessity for user involvement to be equated with representativeness in order to be legitimate and valuable 21,47 .…”

“…The data have wider implications beyond the study site for other community participation strategies where community representatives are appointed to committees or working groups with health professionals. Clarity and agreement between different stakeholder groups about the roles community representatives can and should take on have been identified as a major obstacle to effective community participation 5,33–35 …”

Human rights in health systems frameworks: What is there, what is missing and why does it matter?

“…There is strong evidence of the value of client participation in the design of health systems. Local health and hospital boards, for example, have demonstrated the value of community participation in health governance structures to ensure better health services (Gorsky 2008). At the community level, as only one example, participation has led to great advances in disease control, including through the deployment of lay health workers, such as Directly Observed Therapy Short-course supporters for tuberculosis treatment (Newell et al 2006).…”

‘Creating NHS Local’: The Relationship between English Local Government and the National Health Service

“…Writing 50 years after the publication of the 1944 Wartime Coalition White Paper, A National Health Service , Powell (1994) revisits the history of the foundation of the NHS, summarizing arguments put forward at the time and more recently for a local government‐based health service (see also AMA 1991; Harrison et al . 1991; Knowles 1993; White 2004; Gorsky 2006). Although ultimately overruled by the then Minister of Health, Aneurin Bevan, Ministry of Health officials and Labour Party policy both initially emphasized that health care should be run by locally elected representatives.…”