Of the three core features of cooperative membership – information, voice and representation – members of a foundation trust have representation, but patchy information and no voice. This either leads to an ownership deficit, or the feeling that the governors are somehow the members. There are some exceptions, not least in the mental health field, just as there are exceptional health mutuals outside of the NHS. Benenden Healthcare, for example, has a membership of 900,000, organised in branches, and with a highly democratic structure. It has been voted the UK’s most trusted healthcare provider for three years running. But Benenden exemplifies not just satisfaction but also responsibility. The claim rate on services is significantly lower than for private health insurers because, rather than seeing it as an individual consumer transaction, Benenden members are aware that they are drawing on support that is pooled and to be shared equitably for all members according to need.