‘Labour must not weaken democratic accountability in the NHS’

Buried in the government’s 10-Year Health Plan is a proposal that could fundamentally change how the NHS is run: removing the legal requirement for NHS Foundation Trusts to have councils of governors. It is framed as modernisation. But having served as a Public Governor at both Guy’s and St Thomas’ NHS Foundation Trust and King’s College Hospital NHS Foundation Trust, I know how significant this change would be, and why Labour must think carefully before allowing democratic accountability to slip away.

This is not about defending a structure for the sake of it. The governor model can and should evolve. But abolishing governors altogether risks weakening one of the few remaining ways the public can hold NHS leadership to account, particularly within Foundation Trusts, at a time when the service is under extraordinary pressure.

Governors are often described as the “public voice”, but the role goes far beyond that. We appoint non-executive directors, approve the chief executive, sign off major transactions and constitutional changes, and provide constructive challenge on performance. These are not ceremonial functions. They are part of the democratic fabric of Foundation Trusts, and they matter.

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I have seen this first-hand. At Guy’s and St Thomas’ NHS Foundation Trust, after raising concerns about how little we were engaging with Lambeth schoolchildren, I worked with the Head of Widening Participation, whose commitment and creativity genuinely impressed me. She was determined to open doors for young people who might never have imagined a future in the NHS, and together we strengthened that work and built a more confident bridge between the Trust and local young people. I also helped bring together Lambeth Youth Council and Trust staff for a careers event showcasing the breadth of NHS roles.

I have also found that staff, including Black staff who may not always feel fully heard in formal settings, often share their experiences with me because they trust that I will listen and reflect them accurately. Everyone talks about ethnic disparities, but the lived reality can be awkward to name. As one of the few Black voices in the room, I take seriously the responsibility to make sure that reality is not lost. Bringing those insights into governor discussions, in a constructive and responsible way, is part of the independence and value of the role.

What is often overlooked is the breadth of experience governors bring. Councils include people with backgrounds in healthcare, local government, business, law, education and board-level leadership, but also volunteers, carers, retired people and those whose working lives have been in completely different sectors. Some of the most determined contributions come from people who simply care deeply about their local NHS and are willing to put in the time. One governor recently spent nine months gathering evidence on parking issues, taking photos and raising concerns until a practical solution was found. That persistence, from people of all backgrounds, is part of the strength of the model.

At King’s College Hospital NHS Foundation Trust, governors represent more than 20,000 voting members across patient, public, staff and partner constituencies, but our accountability extends far wider than that. As patient and public governors, we represent the interests of everyone who uses the Trust’s services, including the one million patients Kings treats annually. This is not symbolic. It is a real democratic link between the Trust and the people it serves.

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Nationally, the proposals raise serious questions. NHS Providers has already noted that removing the statutory requirement for councils of governors by April 2027 would require a clear and workable alternative. Key responsibilities, from appointing non-executives to approving major transactions, would need to be redistributed, yet no replacement governance structure has been defined. The government argues for more “dynamic” engagement mechanisms, but data and digital tools cannot replace independent scrutiny or the human insight that comes from lived experience.

Recent discussions at King’s College Hospital NHS Foundation Trust have reinforced this. Governors routinely raise issues that never surface through surveys or dashboards, including concerns about clinical environments, patient transport, digital systems, estate planning, winter pressures and leadership continuity. These are the kinds of things you only hear when you are close enough to listen, and when people trust that you are not part of the management hierarchy.

Some have suggested replacing governors with patient, staff or community representatives. Representation matters, but it is not the same as having a structured, independent body with defined responsibilities and a direct relationship with the Board. Any alternative would need to match the independence, continuity and accountability that a Council of Governors provides. That clarity simply is not there yet.

For Labour, this is a moment to be clear about what we value. Our movement has always believed in decentralisation, democratic participation and public accountability. A modernised governor model could reflect those values: more representative, more inclusive, more connected to local communities and better supported to do the job well. Reform is possible and needed. But any change must protect the patient, public and staff voice, and ensure that independent scrutiny remains part of the system.

The NHS belongs to all of us. Accountability is not optional. Governors, for all our imperfections, remain sone of the few structures that keeps that principle alive. Strengthen the model, modernise it, make it work better, but do not take away the one mechanism that ensures the public still has a seat at the table.

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