The Scalpel's Blog

25.09.19

NEDs are part and parcel of the decision making process

John Coutts, policy advisor for governance at NHS Providers, explains the role of non-executive directors (NEDs) and the impact they can make in the NHS decision-making process.

Non-executive directors (NEDs) have been part and parcel of the make up of NHS boards for many years and their role and function is familiar to many.

There is a general consensus that non-executive, constructive challenge remains central to the successful management of risk that will be essential in implementing the Long Term Plan and moving to system working.

But references to the key role of the trust NED have become less explicit in national policy documents in recent years. This blog unpicks three common misconceptions about the role of NED to set the record straight, and explores how NEDs must continue to support and challenge NHS organisations.

The role of the non-executive director

The nature of the NED role is, to some extent, self-evident from the name. They are directors and board members and as such have the same status as executive directors.

Unlike executives who manage the organisation, non-executives have no executive powers, so they cannot, as individuals instruct or direct staff or work for the trust. But their duties, responsibilities and liabilities as board members are identical to those of executive directors.

READ MORE: Building better boards - the role of non-executive directors in ensuring clinical quality and patient safety

Ideally NEDs bring outside experience to the boardroom, but executive directors may also have experience outside of the NHS.

Where NEDs differ from executives is that NEDs bring an independent perspective to the board that executives who are an integral part of the organisation cannot bring.

NEDs form a majority on trust boards and this, combined with their independence, helps to create a questioning dynamic in the boardroom that ensures risk to the implementation of strategy are subject to appropriate challenge and that the board seeks robust assurance that what they think they know is supported by evidence.

Challenges and opportunities

In recent years, we have observed several themes that suggest the role of the NED is less well understood in national policy making circles than once it was.

First NEDs are increasingly being asked to take on what amounts to executive duties.

Secondly NEDs are often being seen as part of a broader oversight function in systems rather than as board directors.

Finally sustainability and transformation partnerships (STPs) and integrated care systems (ICSs) tend to be led by executive representatives from the component partner organisations, NEDs are generally missing from decision making as directors at a system level.

Taking the quasi-executive role first: NEDs being asked to act as ‘champions’ in certain areas of a board’s work.

READ MORE: Three new non-executive directors join the NHS Supply Chain board

READ MORE: Three new non-executive directors to join NHS Digital

Many NEDs do a first class job in the champion role and I do not wish to detract from their efforts. But the essence of the board director role is that directors do not have portfolios in the boardroom. They are jointly and severally responsible for the entire range of the board’s work, not just part of it.

Furthermore if the champion role involves work outside the boardroom, which surely it must, then this takes NEDs away from being non-executive and therefore detracts from their independence. Foundation trusts can only delegate to executive directors and committees of directors, so they cannot lawfully delegate a champion role to a NED if it involves any work outside the boardroom.

This leaves the NED in question awfully exposed. NHS trusts can delegate to NEDs, but it is debateable whether this is good practice given the central importance of NED independence as a safeguard against groupthink. While it is laudable that boards are asked to take particular care in certain aspects of their work, it is debatable whether having champions is the best way to go.

Another recent development which is understandable but carries risk has been the creation of system wide forums in some STPs/ICSs which group together foundation trust and trust NEDs with clinical commissioning group lay members and non-cabinet councillors as a group. While we fully understand that local system partners see a need for a challenge and oversight group to help scrutinise system level decisions across the system footprint it is essential to recognise the considerable diversity across these three different roles that have little commonality other than the fact that they are not executive.

iStock-525032864

"NEDs form a majority on trust boards and this, combined with their independence, helps to create a questioning dynamic in the boardroom"
 

NEDs are not scrutineers of trust board decisions but part and parcel of the decision making process.

Nor are they part of the NHS’ public engagement function, important as that is, in its own right. As board members NEDs stand for the owners of their organisations – in the case of the NHS the public, but so do their executive colleagues. An oversight/scrutiny and patient champion role at system level is a far cry from a NED majority on local trust boards with a significant impact and indeed a potential veto on board decisions.

I am certain that there NEDs performing a useful role in oversight of system leadership groups. But it is equally important for colleagues in the national bodies to recognise that the development of forums such as these, is a ‘fudge’ being undertaken by committed local partners seeking to establish appropriate governance arrangements, in the absence of a legal framework which allows for non executive challenge at the system level.

READ MORE: From post office to national health service

NEDs as directors need to be part and parcel of the decision making process by forming committees in common that take system level decisions rather than this being left to groupings of chief executives. In the longer term, there may well be argument for systems (STPs/ICSs) to be led by unitary boards made up of NEDs and executives but we are some way off that.

Finally NEDs also need to ensure that challenge continues to take place back at their own board, so that systems can be helped in managing existing and new risks as they are identified.

For this to continue to happen effectively there has to be a clear understanding of the role, something that takes a little effort, but is not in itself a challenge. In our view, the role of NED carries the right combination of responsibility and skill to make a powerful and valuable contribution to the role provider boards play within a newly formed world focused on collaboration, and system working. To realise that potential we need to understand what the role is, and just as importantly, what it is not.

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

MS Society announces 13 new tech projects worth £1.3m

06/12/2019MS Society announces 13 new tech projects worth £1.3m

Multiple Sclerosis Society (MS Society) announced this week (Dec 3) that they are committed to raising £1.3m to fund 13 new research projec... more >
Nuffield Trust: One in four hospital staff born outside of the UK

06/12/2019Nuffield Trust: One in four hospital staff born outside of the UK

New statistics analysed by Nuffield Health show that people born outside the UK make up for almost a quarter of all staff working in hospitals an... more >
Moulding The Future With 3D Printing

06/12/2019Moulding The Future With 3D Printing

Source : NHE Nov/Dec   Professor Peter Marsden, head of Medical Physics & Biomedical Engineering, UCLH 3D printing i... more >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

last word

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad, president of the Association of the British Pharmaceutical Industry (ABPI), sits down with National Health Executive as part of our Last Word Q&A series. Would you talk us through your career in healthcare? My parents both worked in the NHS on the frontline. My mum was a GP, and my dad was a nephrologist in inner city L... more > more last word articles >

the scalpel's daily blog

Caregivers are looking for meaningful work

03/12/2019Caregivers are looking for meaningful work

Ergotron EMEA discusses how they can support organisations to make caregivers’ work meaningful and promote better wellbeing. Caregivers always focus on sharing their dedication to their patients. However, this choice is unfortunately not always up to expectations: the lack of staff, the demanding workload, the system’s digital... more >
read more blog posts from 'the scalpel' >
332 304x150 NHE Callout banner.

comment

NHS England dementia director prescribes rugby for mental health and dementia patients

23/09/2019NHS England dementia director prescribes rugby for mental health and dementia patients

Reason to celebrate as NHS says watching rugby can be good for your mental health and wellbeing. As the best rugby players in the world repr... more >
Peter Kyle MP: It’s time to say thank you this Public Service Day

21/06/2019Peter Kyle MP: It’s time to say thank you this Public Service Day

Taking time to say thank you is one of the hidden pillars of a society. Being on the receiving end of some “thanks” can make communit... more >
Nurses named as least-appreciated public sector workers

13/06/2019Nurses named as least-appreciated public sector workers

Nurses have been named as the most under-appreciated public sector professionals as new research reveals how shockingly under-vauled our NHS, edu... more >
Helpforce to launch training programmes for NHS volunteers

10/06/2019Helpforce to launch training programmes for NHS volunteers

Kay Fawcett OBE, clinical advisor and education lead at Helpforce, and Lynn Twinn, talent development consultant, outline the new national traini... more >

health service focus

View all News

interviews

Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

24/10/2019Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

Today, speaking at the Royal College of General Practitioners (RCGP) annual conference, Matt Hancock highlighted what he believes to be the three... more >
NHS dreams come true for Teesside domestic

17/09/2019NHS dreams come true for Teesside domestic

Over 20 years ago, a Teesside hospital cleaner put down her mop and took steps towards her midwifery dreams. Lisa Payne has been delivering ... more >
How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >