Stephen Twist - former NHS Governor proving impartial insight

11/02/2026

It seems that the new Council of Governors will meet at Darlington Memorial Hospital tonight at 1700 hrs. Borsha, your newly-elected Darlington representative shall be attending. From the CDDFT web it seems that the Trust hasn't shared details publicly, shared an agenda or taken any steps to permit online observation. Why might this be? Is this consistent with the Trust's commitment to openness?

The Council of Governors (CoG) works alongside the Trust's Board of Directors to ensure that local communities and staff have a greater say in how services are developed and delivered by the Trust. The CoG is made up of local people, staff members and representatives of local stakeholder organisatio...

09/02/2026

https://www.hsj.co.uk/workforce/nhs-sheds-thousands-of-managers-and-support-staff/7041045.article

The expansion of large parts of the NHS's non-clinical workforce has started to reverse for the first time in years, figures show.

08/02/2026

Ian highlights this development between Guy's and St Thomas' hospitals in London. With Darlington Amazon flying their first deliveries, how about linking our 11 GP practices to Darlington Memorial Hospital's pathology department by drone?

What started as a slightly sci-fi experiment above central London is quietly turning into everyday NHS logistics.

31/01/2026

At midnight last night my role as your publicly elected governor of County Durham and Darlington NHS Foundation Trust came to an end, and I had the privilege of handing over to my highly competent successor, Borsha Sarker who I know will make a tremendous impact and provide considerable support for the people of Darlington. Borsha and I (joined later by Keith and Stephanie) were able to spend updating downtime after a full day of excellent Governwell training. This is Borsha's second term of governance and she already signals special insight into the workings of the Trust that will support you over the next three years.

It has been an honour representing your interests on the Board of Governors. Not always easy - holding the non-executive directors to account has been a challenge, not least due to their (and the management's) failure to respond/ lack of diligence/ absence of curiosity - and in some cases - serious incompetence. Hopefully, the new management and vastly improved team of NEDs will make the task of oversight easier for Borsha.

I will remain as a correspondence resource for my friends on the Council of Governors, to support them should they need me. And for you, my faithful supporters, my thanks for putting your trust in me to represent your interests and take forward your concerns.

31/01/2026

On Thursday I attended the Organ Donation Joint Working Group Webinar, setting out the group's proposals for this year and beyond. The principal issue is a reduction in donation registration, leading to a shortage of tissue for donation. If you are reading this, please don't rely on the fact that current legislation provides for 'deemed consent'. Sign up. And tell your family that you have signed onto the register and why. This way, following your death, your family will not feel conflicted or left in any doubt about your intentions.

27/01/2026

New AI notetaking tools being backed by the NHS could help doctors spend up to a quarter more time with their patients.

NHS organisations across England are being urged to take advantage of a new national registry of 19 suppliers for the technology, which captures clinician–patient conversations and uses AI to accurately generate real-time transcriptions and clinical summaries, while ensuring data protection.

Embracing the cutting-edge tools, known as ambient voice technologies, could save clinicians up to 2 or 3 minutes for each patient consultation, freeing up more time for them to see other patients.

On Friday 16 January 2026 NHSE published a new self-certified registry for the technology, which requires suppliers to comply with standards on clinical safety, technology and data protection.

The registry of suppliers is being launched following NHS guidance published last year advising NHS organisations to use AI notetaking tools which are safe, evidence-based and deliver benefits for patients.

26/01/2026

£603,000 spent directly by CDDFT on litigation against their nurses. There will be other substantial costs - in staffing, loss of labour, and compensating the nurses for discrimination and harassment. These are not yet disclosed.

Further questions remain yet to be answered: 1. Did the new CEO, (who took office before the final hearing started) seek to stop the litigation, and if not, why not? 2. Why is the non-executive director who stage-managed the litigation still in post given non-executive advice was very clearly flawed? 3. Why did it take the disaster of this critical judgment to force the Trust to reach out to the nurses in a meaningful way and to meet their obligations as a fair employer of all its workforce?

Here is the CEO's statement on behalf of County Durham and Darlington NHS Foundation Trust.

15.The reserved judgment in the Employment Tribunal case concerning staff changing-room facilities at Darlington Memorial Hospital has now been issued.

16.The Tribunal upheld elements of the claims relating to harassment connected to s*x and gender reassignment, finding that requiring the claimants to share a female changing room with a trans woman amounted to harassment, and that the Trust did not respond adequately to concerns raised by staff, contributing to an intimidating environment. The Tribunal found that aspects of indirect s*x discrimination succeeded.

17.Other claims.... were dismissed.

18.We have acknowledged these findings and recognised that we did not sufficiently consider or address the concerns raised by some colleagues. On behalf of the Trust, I am sorry for the distress caused to all colleagues impacted by this. Work is already underway to review relevant policies, improve the provision of private changing spaces, engage with colleagues and staff networks, and ensure future arrangements align with the law. National guidance is still awaited but the judgment is binding on the Trust and as such we intend to take action to ensure we are compliant with the judgment. Further updates will be brought to the Board as actions progress.

19.Recognising the significant public interest, I also wanted to advise the Board of the cost of the litigation, which is c£603k up to the end of the tribunal. We know there will be concerns about this. We will review our approach to identify whether there were missed opportunities, and we will also give consideration to enhanced
Board oversight through the relevant committee.

20.I have reviewed the outcome with colleagues and the Trust will not appeal the findings of the Tribunal. We contacted the claimants legal representatives on the day of the judgment to acknowledge the findings and to seek further discussions to try and resolve the issues.

26/01/2026

Resident doctor strikes in England (2023–2025) have resulted in significant disruption to the NHS, with over 1.7 million appointments, tests, and operations postponed. From today's HSJ: 'As the dust settled on the latest resident doctors strike, a group of medical and managerial senior executives met to review how their London acute trust had fared.

The answer was ”very well”. As is usually the case when senior medics are moved into roles which bring them into contact with patients earlier, and at crucial points like discharge, most metrics improved. Care was safer and smoother.'

The outcome, clearly, was not to sack the resident doctors, but raises the debate about the effectiveness and efficiency of the current model.

As the dust settled on the latest resident doctors strike, a group of medical and managerial senior executives met to review how their London acute trust had fared.

24/01/2026

The ‘shadow director’ scare - to read the full article with links, go to https://stephentwist.wordpress.com/2026/01/24/the-shadow-director-scare/

A post about NHS public governors and whether they are at risk of director liability.

On 11 November 2025 the Interim Chair of County Durham and Darlington NHS Foundation Trust wrote,

‘I am becoming increasingly concerned about the blurring of the lines between the role of Governor and the role of a NED. As you will be aware, the performance of the Trust is the business of the Board and the performance of the Board is the business of the CoG. The Board members, both Executive and Non-Executive, are statutorily responsible for the organisation and carry the accountability and liability which goes with that. If others are seen to be directing the Board and the organisation, they potentially assume that accountability and liability as shadow directors which is not a position I want the Governors to find themselves in. I am concerned that your paper has the potential to cross that line.’

The Interim Chair is quite right in her analysis of roles, and possibly correct that my paper may have ‘crossed the line’ in the way it was expressed, regardless that the suggestions were pertinent at the time – and despite my express qualification: ‘Here I offer a few thoughts and ideas – not in any way to direct or distract, but to signpost some proposals that may contribute to effective governance by our Council of Governors.’

But what of the suggestion that this could lead to governor liability as a shadow director? Let’s examine that.

Could a governor be held liable as a shadow director under the Companies Acts?

Section 251 of the Companies Act 2006 reads, ‘In the Companies Acts “shadow director”….means a person in accordance with whose directions or instructions the directors of the company are accustomed to act.’

Key features required for a shadow directorship include:

A pattern of board actions following the person’s instructions.
Influence over decisions that are reserved to directors.
Influence that goes beyond raising concerns or offering challenge.
Courts have repeatedly emphasised that ordinary challenge, oversight, or representative functions do NOT constitute shadow direction Re Hydrodan (Corby) Ltd; Secretary of State v Deverell.

The statutory duties of Foundation Trust governors are set out in the NHS Act 2006, as amended by the Health and Social Care Act 2012, and in NHS England’s official guidance. According to NHS England’s Your statutory duties: A reference guide for NHS foundation trust governors (and addendum):

Governors do not manage the trust. They “challenge the board of directors and hold the non-executive directors to account for the performance of the board.”

Governors represent the interests of members and the public and do not become involved in operational management.
The question that remains is – ‘Does highlighting an issue pertaining to management – equate to becoming involved in operational management?’

Highlighting issues and proposing solutions is part of good, constructive and worthwhile governance. Supressing proposals on the grounds that they may cross a line is a quick way for a Foundation Trust to forfeit great ideas that may benefit public health – and possibly save a Trust from the ignominy of error.

For the future, perhaps we should approach good governance as a collective of ideas generated from many viable sources, that are advanced for the collective good – leaving the executive to sift filter out and only implement those that will assist in public health care provision?

23/01/2026

Impartial insight! That’s not to say that my posts here have been less than objective over my time as Governor, but as an elected representative from time to time there were inevitable restrictions on what I could say. With the passing of my 3 year term I am now free to comment more deeply - and where appropriate , critically.

I would like to form a community of commenters- Trust members, current governors, patients, their families and others with ‘skin in the game’. If you prefer to comment anonymously simply send a message and I will add it to the thread.

22/01/2026

Each year in February the County Durham and Darlington NHS Foundation Trust Council of Governors has been invited to appoint/reappoint their Lead Governor.

The role of Lead is very much what an incumbent wants to give. A Lead has no extra powers, but does have significant influence arising from the invitation to attend Board's private sessions and meet regularly with the Chair. A number of current members feel that the Council needs the assurance of a Lead who can report back with objectivity and has that 'curiosity' that has been absent.

Stephen Picken is an excellent candidate, bringing a fresh energy and an accessible vigour. New governors would benefit from a Lead who is proactive, but reasonable, sensible and caring.

Nomination for Lead Governor: Stephen Picken

Our Council of Governors brings together a wide range of perspectives — appointed medical colleagues, stakeholder representatives, and publicly elected governors, including those joining us for the first time this month. The Lead Governor must be someone who can bridge these groups with clarity, respect, and balanced leadership. We believe Stephen Picken, with 40 years of NHS experience, offers precisely those qualities, and it is our pleasure to nominate him for this role.

Stephen combines mature judgement with real vitality. He brings the steadiness that comes from experience - yet pairs it with the energy and responsiveness that help a Council genuinely move forward. He is thoughtful, active, and fully engaged — a governor who prepares carefully, listens well, and participates with purpose.

What sets him apart is his constructive approach to challenge. He asks the right questions, at the right time, and always with professionalism. He probes issues intelligently and persists until answers are not only given - but understood. Yet he does so with courtesy and balance, maintaining strong working relationships even in moments where scrutiny is needed. This is an essential quality for any Lead Governor seeking to strengthen our collective voice.

Stephen is also resolute, but not immovable. When he holds a view, he does so for principled reasons — but he remains entirely willing to listen, reflect, and adapt when presented with evidence or alternative insight. It is this blend of independence and openness that helps a Council function at its best.

Above all, Stephen brings a genuinely caring mindset to the role. He thinks deeply about the implications of decisions, not only for the Trust but for patients, families, and staff. His commitment to public service is evident in the way he conducts himself: friendly, approachable, and considerate of others’ viewpoints, while keeping the wider purpose firmly in sight.

As both Trust and our Council face new opportunities and challenges — and we welcome new governors into our ranks — we have an important moment to reaffirm strong, balanced, and effective leadership. Stephen offers the robustness, clarity, and proactive engagement needed to carry the role forward with confidence and integrity, whilst honouring and building upon the work of those who have previously served.

For these reasons, the caucus commends Stephen Picken to you as a Lead Governor who will represent all governors fairly, support collaborative working, and help guide the Council with both strength and sensitivity.

17/01/2026

I had it in mind to provide an objective summary of yesterday's Tribunal decision (given that it comprises 449 paragraphs of legal reasoning - however two correspondents suggested that I set it against an account of my involvement, the interventions that I made and steps I took in support of both the Trust and the nurses. Here it is -

A personal post about a cost in human and financial terms that could have been avoided if NHS managers had been responsive to all parts of their staff, rather than slaves to poor policy decisions. …