It's good to talk: Non-executives and the Covid-19 crisis

by Usman Khan, Senior Advisor to the Good Governance Institute.

For close on 18 months since the beginning of the first lockdown, the Good Governance Institute has put on a weekly webinar for non-executive directors to engage in a facilitated discussion, following the theme ‘good governance in times of crisis’. I have been privileged to have facilitated these meetings, which have seen up to 100 colleagues debating topics that have ranged from the challenges of securing PPE to the impact of Covid on minority ethnic groups.

The context for these webinars is that as the NHS has experienced a once in a lifetime shock, so has its system of governance. For many non-executives, the immediate period after the first lockdown saw an immediate and stark rewriting of their rule book. Central direction relating to the establishment of ICSs and ICPs was put in abeyance and Board scrutiny turned down to simmer, all of which left many non-executives struggling to find purpose at this most critical juncture. Within such a setting, high levels of emotional strain became evident within a grouping which whilst distanced was still inextricably part of the tumultuous journey.

The hiatus was short-lived, and as the response agenda evolved so the role of the non-executive rapidly came back into focus. Reflecting on the journey, the non-executive webinars provided a helpful and timely outlet for thoughts and views, an outlet that mirrored a wider process of reflective transformation regarding the role of the non-executive, one of which the consequences are likely to be long-standing. In the process of transformation three interwoven themes can be identified relating to Engagement, priority setting and strategic alignment.

Firstly, it was evident from an early juncture that Chair’s, Boards and Non-executives had taken little time to recognise that the nature of the challenge faced by their organisations required them to take a step back from their traditional scrutiny role in order to release their executive colleagues to face deal with a rapidly developing set of operational challenges. Having done this the non-executive community turned rapidly from physical to virtual platforms, to rally their workforce, support management and connect with often anxious communities. WhatsApp, Zoom and Twitter became platforms to both extend and deepen reach, enabling non-executives to act as valuable conduits and lightning rods for increasingly fragile health systems.

Secondly, maintaining and developing the vital threads of engagement into local health communities established by NEDs during the first waves of the Covid pandemic was of particular importance. Without such connections, it is likely that emergent themes such as the differential impact of the pandemic on black and minority ethnic staff and communities would not have been profiled as promptly or powerfully.

Finally, the NHS had already embarked on a new chapter in its evolution, as it moved away from the market and towards a new vision of partnership working. The yoke of the market has been cast off, with few lamenting its demise. But its passing leaves a vacuum and the as the duty to collaborate was rapidly promoted from policy aspiration to operational necessity, it has been non-executives who have played an increasingly important role in building bridges across the NHS as well as beyond it.

The prevailing political direction of travel does not often lend itself towards support for independent free-thinking governance. Yet in that first tumultuous period, it often appeared to be that free-thinking which enabled the governance system to adapt and in doing so to find a new purpose at a time of need. There is then a risk that as substantive elements of the old order are reimposed, that the value reaped following the initial hiatus may dissipate. If for instance, the establishment of ICSs results in Trust non-executives being marginalised, then some of the momentum they lent to engaging with communities, improving collaboration, and informing strategic prioritisation might dissipate? If the communication channels that allowed meetings not of tens but of hundreds of frontline workers or local communities to connect with Boards and most particularly with non-executives are allowed to whither, then a valuable trust-building bridgehead could be lost.

The enduring lesson can be said to be that the importance of the non-executive in health system governance has withstood the impact of the Covid 19 crisis and in many ways have come away from it strengthened with regard to purpose and value. However, such gains must now be consolidated at the level of place as they must be at a system level, which with the current levels of fragility will be a challenge, but a challenge worth meeting.