Working together on what comes next

Everyone we have spoken to has emphasised the importance of public accountability and of seeking out and acting on the voice of patients and the public. The announcement presents an opportunity, many felt, for councils of governors to work with their boards to develop proposals for what comes next. 

FTs take different approaches to patient and public engagement and to being publicly accountable. Some FTs already have well-developed mechanisms running alongside the council, which governors may be involved in. Others will be starting from a less developed base. Equally, developments in ways of working, for example of neighbourhood services, may offer new opportunities for meaningful and constructive local engagement. 

FTs already have a statutory duty (Section 242 of the NHS Act 2006) to involve users of services (patients, carers and their representatives) in the following, where a proposal or decision would affect the way services are delivered and/or the range of services available: 

• Planning the provision of services, 
  
  
• Developing and considering proposed changes in the way services are provided, 
  
  
• Decisions affecting the operation of services. 

Statutory guidance from NHSE (Working in Partnership with People and Communities (2022)) sets out how organisations should meet this legal duty, including the principles of good public and patient involvement and expectations about how involvement should be embedded in planning and service change. 

We have worked with trusts to understand the impact of removing councils on patient voice and published a summary report. FTs and councils may find this helpful when planning together. One area where many people we spoke to felt that trusts could do better was on engaging with a more representative and diverse group of stakeholders than the elected governor model sometimes allowed. It will be worth considering this when planning for what follows. 

Public accountability is distinct from patient and public involvement. NHS organisations have some public accountability mechanisms built in, for example through transparent annual reporting, holding board meetings in public, and ultimately through accountability to the electorate via Parliament. These are statutory public accountability requirements that we expect to remain. Councils and boards will want to work, perhaps with FT staff and public members, to develop options to ensure public accountability remains embedded in the trust. In particular, those we spoke to noted that without councils of governors, there is no statutory mechanism for public, staff and stakeholder involvement in annual planning or in holding the NEDs to account for the performance of the board.

There is another piece of forthcoming legislation that is also likely to affect the approach trusts take to public accountability and is worth considering when planning for a future state without councils of governors. The Public Office (Accountability) Bill seeks to introduce a legal duty of candour (with criminal penalties for non-compliance) requiring NHS organisations and those working in them to act with candour, transparency and frankness in all dealings with inquiries, inquests and investigations. This Bill was introduced to the Commons in September 2025 and is still progressing through Parliament. If passed, this will impact on the approach trusts take to disclosure of information and mean trusts should actively seek to embed candour at all levels of their organisations. It is worth bearing in mind when considering what might be required of your trust in the future.