23 July - NHS non-executive directors webinar

This week’s session opened in conversation with Alan Palmer, non-executive director at North Middlesex University Hospital NHS Trust.

Alan said: “It seems to have been left to ICSs to work out the role of NEDs within their structures themselves at the moment. Meanwhile we carry on working at our level and try to take account of any changes coming in from the ICS. I feel very strongly about the independence of non-executive directors and I think this should be their role first and foremost. I think therefore that NEDs of provider trusts may not necessarily be the best people to sit as NEDs on ICS boards as they may find it difficult to distance themselves from their own provider trust and lose that independence.” […]

“If we create great monolithic ICSs, the scrutiny applied by non-executives would need to be far above that needed at organisational level. This wouldn’t be impossible but it would be a challenge. If you’re covering a huge patch there may be too much to cover and it won’t have the same level of quality in the scrutiny.”

Also overheard during today’s webinar:

“Foundation trust non-executives have an accountability to the governors, who are likely to remain focused on their obligation to their local population rather than system population. NEDs of these trusts will need to stay focused on governor concerns as well as system priorities.”

“We’re trying to ensure that all of our key workstreams within the ICS have NED involvement and input and are setting up our governance structures around this. We’ve had to push the senior team in the ICS and say we want to be part of this. You have to make the effort to be part of the journey. Sitting back will mean we’re not part of the process.”

“It feels like there is a wide lack of clarity on the emerging ICS landscape. It feels like the direction of communication is from above down rather than a two-way process and there is not much we can do. I think as NEDs we should take a proactive role but I feel at a loss as to how and where to engage. I also wonder who is advocating EDI agenda in this development.”

“I think we can be optimistic as long as form follows function and we focus on better population health as the prize. Locally we are seeing signs of sharing of thinking and many of our NEDs have wider networks in other parts of the public and private sectors that help us triangulate better and add to the discussions – even though we are still in the foot hills of ICS formation.”

“With any changes there will be challenges and opportunities but we need to forge a way through so that we are central to the discussions. There is a clear role for the NEDs to be pushing this agenda forwards about tackling social issues.”

“The primacy of place will be crucial. The worry is that this will fall foul of a top-down approach from the ICS boards as the infrastructures evolve. We must make every effort to ensure that that the huge benefits of the ICS partnerships as coalitions of the willing are not lost in a top-down approach from ICS boards.”

“Place is central to a lot of our thinking – especially in a large ICS patch with a patchwork quilt of very diverse place needs.”

These meetings are by invitation and are open to all NHS non-executives directors, chairs and associate non-executive directors of NHS providers. Others may attend by special invitation. For further details, visit our events page.

If you have any comments, questions or suggestions about these webinars, please contact: events@good-governance.org.uk.