Background

A document released by NHS England, NHS Improvement and NHS Clinical Commissioners has raised important questions about the evolving role of lay directors and members of NHS organisations. See ‘Supporting change in your NHS’ . It reports on the views of over 200 non-executive directors (NEDS) and lay members at events hosted this autumn.

Many have been in post for some time so have settled into an effective modus operandi with clinical and operational colleagues. In theory, their role can provide an external perspective, and many bring to the table a wide experience of other stakeholders.

The issue

The alarm bells ring when it is said that, in the context of Sustainability and Transformation Partnerships (STPs) and Accountable Care Organisations (ACOs), ‘there are only a few examples of lay members and NEDs being actively involved in leadership conversations.’ Clearly there is a risk that the people chosen to represent the wider public interest are being by-passed. In their own words ‘This highlights some concern that there is limited lay scrutiny and challenge during the development of plans or the decision-making process.’

Elsewhere in the document, it is good to see an acknowledgement that this situation needs actions – by the relevant NHS organisations and by those running the STPs themselves.

Observations

The Institute has long had concerns about the relative invisibility of NEDs and lay members on some NHS Boards when it comes to controversial service changes. We would prefer to see them actively driving the commitment to engage and consult adequately, and insisting that the full meaning and intent of legislative (i.e statutory) obligations are being observed, or even exceeded.

It is therefore worrying if they feel unable to have much influence on STPs. The new partnerships are pivotal to the transformative changes often required, but they have been bedevilled by complaints that there has been inadequate engagement with key partners and stakeholders.

The Institute is regularly delivering training courses, risk assessment workshops or executive briefings throughout the health and social care sectors, but rarely are NEDs and lay members invited to attend. Is there possibly a misplaced sense that the detail of best practice engagement and consultation is something only for operational managers? Or have NEDs and lay members themselves expressed reluctance to come along?

One thing is for certain, if big-time politics intervenes, (like Nick Boles asking the Prime Minister directly about Grantham Hospital this week) or the media fights a campaign critical of a local NHS body, all directors whether executives or not, feel the heat. And if there is a legal challenge with a judicial review in the High Court, the Board as a whole can be on trial for its acts or omissions.

So, we wonder if it might be time for the Institute to offer a special package to help deepen NEDs and lay members’ understanding of the legal and best practice requirements that will help them shape the decisions of the Boards on which they serve?  We are happy to receive suggestions.

*Sustainability and Transformation Partnerships