We talk to some non-executive directors taking part in our Board leadership programme about the challenges of ensuring effective governance in the midst of the reforms.
Governance in a new health environment
We need to recognise this world is different, and we'll be working with partners in a different way, in co-production and collaboration.
The unpredictability of the current health policy environment is adding to the pressures facing NHS board members as they look to lead their organisations and maintain strong governance through financially straitened times. 'For non-executive directors, there is more uncertainty now and there's certainly more risk.' says Sian Bates, who chairs NHS Richmond and four other primary care trusts (the South West London cluster). 'As non-executive directors (NEDs) are accountable, that is quite a big challenge. We are working in a climate of changing governance,' she says.
Elizabeth Butler, who as chair of Lewisham Healthcare NHS trust is trying to guide it to foundation status, agrees that expectations on non-executive directors are higher than ever. 'No one is making allowances for the fact the world is in chaos,' she explains. 'We have to produce a five-year plan, reflecting commissioner intentions when we don't actually know who our commissioners are going to be next year.' Lewisham Healthcare NHS trust is maintaining a strong focus on clinical quality, 'because that's the biggest real risk. We're also putting enormous effort into our cost-improvement programme as we have to make significant savings.'
Delivering efficiencies in governance
Programme Director, Katy Steward, observes, 'boards are struggling right now – with how they deliver on the efficiency agenda, with realising their financial plans and with anticipating the impact the commissioning changes will have on their business'.
One challenge that many boards are facing concerns integrating or merging services and organisations. For example, some hospitals may be looking to combine their services around care of the elderly or move different services elements out into the community. 'The role for the board in that is first, to recognise it as a strategic priority, and then to ask questions to find out if they are doing enough to create leadership and get hospital clinicians working closely with GP colleagues to map out how services are going to be provided,' explains Katy.
Board leadership programme
The Board leadership programme (BLP) is designed to give chairs and non-executive directors as clear a steer as possible on where government policy is leading and what it may mean for them locally. It also develops their leadership, scrutiny and team-working skills so boards can provide strong oversight and make effective decisions.
Lewisham Healthcare Trust, which has signed up for the programme, says the ability to network, share experiences and good practice has a powerful impact. Sian Bates says, 'I think all our NEDs have taken part in this programme. It does different things for different people. There are updates to understand the changing agenda and opportunities to discuss with other NEDs.'
2011 Board Leadership Programme schedule
This year, the BLP has featured a series of breakfast and evening seminars, with some of the UK's leading experts in health and social care, including David Nicholson and David Bennett.
Seminars reflect the programme's key themes – integration and transforming services, delivering the policy agenda, governance, leadership and QIPP (Quality, Innovation, Productivity and Prevention).
Participants can hear about, among other things, preparing for foundation trust status, integrating services successfully, developing clinical leadership and improving productivity and patients' experiences.
Katy Steward says, 'following the public inquiry at Mid Staffordshire NHS Foundation Trust, there's a high degree of awareness among board members about the need for good clinical governance. The programme helps boards really get to know what is going on in their organisation and ensure they have robust assurance processes.'
Part of the programme involves board observations, after which The King's Fund analysts provide feedback to boards on how they are working. Hattie Llewelyn-Davies, who chairs Hertfordshire Partnership NHS Foundation Trust, says the exercise was 'imaginative – they looked at the way we were interacting and how it affected the discussions and decisions we were making.'
She says that taking part in the programme has been a particular eye-opener for her trust and for the non-executive members who come from a non-NHS background. 'Unlike some programmes, this is not segmented which is very useful for us because it means we, as non-executives, have a chance to really understand some of the pressures of the acute trusts.'
This article first appeared in Insight, a magazine produced by The King's Fund for the NHS Confederation Conference 2011.