The new governance arrangements for NHS foundation trust hospitals: reframing governors as meta-regulators

New governance arrangements for NHS Foundation Trusts (FTs) aimed to replace centralized state ownership of acute English hospitals with a new form of social ownership. Under this, trusts would exist as independent public interest organizations on the model of mutuals and co-operative societies. Assessing the impact of the new arrangements on the management structure of four acute hospitals, we demonstrate that FTs have failed to deliver social ownership and local accountability on this model. We suggest that policy-makers should re-frame the governance apparatus associated with mutualism and social ownership in terms of the concept of meta-regulation. By re-framing governors as meta-regulators, regulatory institutions would acquire new powers to steer FTs towards sustainable forms of compliance via non-coercive, non-intrusive means.