As other HSJ columnists have pointed out, the NHS operating framework for 2009-10, published by the Department of Health in December, sets out a challenging agenda for boards over the next year.

For hard pressed boards, a welcome break from tradition in this year's framework is that it sets no new national targets and carries forward last year's priorities. But that does not mean it is any less demanding than its predecessors.

Instead, this framework has set the operational stage on which boards will need to perform in a post-Darzi world and the script is taking shape.

Following on from High Quality Care for All, one word that stands out above all others is "quality". Non-executive directors and their boards have an important part to play in making the principle of placing quality at the heart of the NHS a reality.

Organisational culture

The leadership challenge to drive forward this agenda at a local level means boards must ensure the quality framework is effectively embedded throughout the organisation.

The key to this is a creative and innovative approach to deliver locally defined quality, while at the same time ensuring national targets are met.

In other words, boards will need to develop an organisational culture of innovation and free thinking that does not create rafts of new targets. So, some ad-libbing is permissible, but not if it changes the story line.

The framework stresses the importance of building a definition of quality that engages and listens to the local population, patients, public and staff. Setting out a clear vision for quality will be a key task for boards and chairs, and non-executive directors will need to ensure the voices of all these audiences are heard in the boardroom and their competing demands are balanced appropriately in the year ahead.

Skilled leaders

The framework has emphasised the importance of ensuring the NHS has leaders with the right skills to deliver this quality vision. Very often, the discourse on leadership in the NHS seems to concentrate on executive and clinical leadership and neglects the critical contribution of chairs and non-executive directors.

However, it is clear that the vision set out in High Quality Care for All and sustained in the operating framework will not be achieved without the strategic drive, scrutiny and challenge that chairs and non-executive directors can bring.

The Appointments Commission is keen to ensure that the non-executive contribution is recognised and supported throughout the service. This depends on us attracting and recruiting the best possible people from a diverse range of backgrounds, providing them with the tools they need through our induction programme and working with strategic health authorities and others to support their ongoing training and development.

We also need to make sure the skills and talents of non-executive directors are used to best effect and are not frittered away in endless meetings or operational detail.

Hook or ovation

To continue the play-acting theme, one of my favourite Christmas treats was a ticket to see La Cage aux Folles at The Playhouse in London and I am reminded of the opening verse of the iconic song "I am what I am":

I am what I am.
I am my own special creation.
So come take a look,
Give me the hook or the ovation.

The operating framework has set the stage - now patients and the public are expecting a quality performance. Let's hope we get the ovation, not the hook!