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Meta-regulation meets Deliberation: Situating the Governor within NHS Foundation Trust Hospitals

Published online by Cambridge University Press:  05 November 2018

Health Services Management Centre, University of Birmingham, Park House, Edgbaston Park Road, Birmingham, B15 2RT email:
Middlesex University Business School, The Burroughs, London NW4 4BT email:
Health Services Management Centre, University of Birmingham, Park House, Edgbaston Park Road, Birmingham, B15 2RT email:
School of Management, University of St Andrews, The Gateway, North Haugh, St Andrews, Fife, KY16 9RJ email:


NHS Foundation Trust (FT) hospitals in England have complex internal governance arrangements. They may be considered to exhibit meta-regulatory characteristics to the extent that governors are able to promote deliberative values and steer internal governance processes towards wider regulatory goals. Yet, while recent studies of NHS FT hospital governance have explored FT governors and examined FT hospital boards to consider executive oversight, there is currently no detailed investigation of interactions between these two groups. Drawing on observational and interview data from four case-study sites, we trace interactions between the actors involved; explore their understandings of events; and consider the extent to which the proposed benefits of meta-regulation were realised in practice. Findings show that while governors provided both a conscience and contribution to internal and external governance arrangements, the meta-regulatory role was largely symbolic and limited to compliance and legitimation of executive actions. Thus while the meta-regulatory ‘architecture’ for governor involvement may be considered effective, the soft intelligence gleaned and operationalised may be obscured by ‘hard’ performance metrics which dominate resource-allocation processes and priority-setting. Governors were involved in practices that symbolised deliberative involvement but resulted in further opportunities for legitimising executive decisions.

© Cambridge University Press 2018 

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