On 1 April 2004, the first 10 NHS foundation trusts came into being, giving local people ownership and accountability for health services. Yet most trusts have found it difficult to persuade enough people to help decide how they operate, writes Professor Rudolf Klein of the London School of Economics.
For example, in the first round of elections for Bradford Teaching Hospitals NHS Trust, well under 1% of the local population voted to elect the 17 governors responsible for the operations of the new trust. The trust's aim was to achieve a modest 10% of the local population.
More surprising was the apathy among the staff of aspiring foundation trusts. In Bradford, only 263 of a total staff of 3,600 voted to elect four governors.
These figures are appalling and might reflect cynicism about the role of the governing boards, says the author. But if the boards do turn out to be unrepresentative, it will be more difficult for foundation trusts to achieve the "freedom from Whitehall control" that they have been promised.
So far there has been no clear statement as to what the minimum level of electoral participation either is or should be, says the author. "If we are to avoid putting a very important experiment in the history of the NHS at risk then the time has come to be explicit about what the standards should be and how they are to be achieved," he concludes.