February 1, 2013 Role of Chair needs to be strengthened at the NHS
The role of Chairperson has a long and proud history in the UK as a bulwark of good governance. Although, there is some debate as to whether an effective board requires a separate chair (an area we have looked at previously; see Should the roles of Chairman and Chief Executive be split?), it is clear that, where there is a separate chair, they should lead the board and set the tone for the meetings and overall governance.
However, it appears that in the NHS, the chief executive is all too often overshadowing the chair. In fact, in a survey undertaken by Grant Thornton, respondents felt that the medical/nursing director and the finance director played more of a role in setting the tone for the board than the chair. NEDs were only just behind the chair in their role in setting the tone. This suggests that the role of chair needs to be strengthened at many NHS trusts if good corporate governance is going to flourish.
The survey also showed that though NHS foundation trusts have been generally making good progress on governance, NHS primary care trusts (PCTs) have a long way to go before they reach similar standards. This is particularly concerning as PCTs work towards a new commissioning structure where clinical commissioning groups will take on many of their roles. It is hoped that they will be up to the task from a governance perspective.
Despite this, there are some strengths and positives to be taken from NHS corporate governance arrangements, especially in the area of Non-Executive directors. 81% of survey respondents felt that NEDs offered an effective challenge which is encouraging. The representation of women on NHS boards also continues to be strong with between 37% and 49% of voting positions being held be women, which should please Lord Davies.
This is a tricky time for the NHS with structural changes, cost pressures and regulatory challenges such as responding to the 2013 publication of the Francis report on Mid Staffordshire NHS Foundation Trust. Good governance will be key to the NHS’s ability to deal with these hurdles and it is hoped that they will be up to the challenge.