How can trusts choose non-executives who are up to the demands of a rapidly changing NHS? Here, we look at the qualities that make a great NED
Trusts need boards that can respond to the rapid changes in the NHS. Increasingly, this means selecting non-executive directors with a broader mix of expertise, while at the same time ensuring they have the core skills necessary to perform the role.
"There has been a sea change in what trusts are looking for in NEDs", says Lisa Rodrigues, chief executive of Sussex Partnership trust, which has recently appointed a new chair. While NED recruitment used to be very community oriented, there is now a growing focus on business acumen and having a more senior cadre, she says.
People with backgrounds in corporate senior management, such as finance or HR, are highly sought after. "They are clearly bright and can make decisions quickly. They understand how to manage the reputation of an organisation. The NHS hasn't always been as business-like in the past, but they can help us with that," she says.
Dr Katy Steward, King's Fund director of the London Board Leadership programme for NEDs and chairs, agrees: "The NHS is operating in an environment that is pushing boards to be ever more strategic and commercial. This does not mean to say NEDs have to be drawn from the private sector (they could equally be from the public or third sectors), but they do need experience of managing complex organisations that enables them to bring maturity and judgement."
The Appointments Commission is responsible for agreeing the board criteria with NHS trusts (except foundation trusts) and recruiting NEDs through advertising campaigns and head hunting in local patches. Increasingly, this involves developing links with businesses.
Its chief executive Andrea Sutcliffe stresses the importance of getting a good mix of people. "It is no good if you have five people who come from the same perspective. We're expecting boards to do an awful lot and deal with an awful lot of change. So they need to make sure they are appointing people who add value," she says.
"I expect chairs to look at the overall balance of the board. We still need people to reflect community interests. Patient safety is a critical issue for boards and they still need people who are saying 'what are you doing about this?' We have to be careful not to throw the baby out with the bath water."
No matter what background, there are common attributes all NEDs need to be able to deliver in their independent roles of providing scrutiny and setting the strategic direction for trusts.
Communication is at the core of good governance, says Dr Steward. "It is about how well they listen and get their point across without being dogmatic and aggressive."
Ms Rodrigues agrees: "They should have fantastic interpersonal skills. They have to be able to raise difficult issues in a nice way. I don't like it when NEDs speak in their own groups, they have got to be able to speak with the board as a team."
She adds that a typical corporate sector macho approach is not particularly welcome on an NHS board. "Macho isn't helpful. Having a good sense of humour and manners is helpful."
It also helps if they have a good memory or method of recording meetings as some people have a tendency to forget what was said at the last meeting and raise the same issues over again, she says.
Dr Steward adds that one of their key attributes should be the ability to frame questions simply. "I was in one meeting recently when a NED asked 'so what is the risk to the patient if we do this?' It is just that sort of question that an NED can ask that gets right to the point of an issue," she says.
Up to speed
One of the biggest challenges for NEDs, particularly those from outside the NHS, is to be confident. "They need to get NHS literate quite quickly and know their PBC from their PbR and the local operating context. But it is a really tricky balance to be able to see the wood from the trees, but at the same time they don't need so much information that they are second-guessing trust executives," adds Dr Steward.
NEDs also need tenacity and resilience, particularly when they are dealing with the thorny issues of service reconfigurations and may be concerned about their own reputations in the local community, she advises.
This is where trusts might want to think about adding to the mix people with change management skills, who can effectively communicate change and act as ambassadors for the trust.
There is much that NEDs can do to prepare themselves for the role. "They need to read widely and know what's going on in their patch. Don't land from Mars not having read the board papers," says Ms Rodrigues.
Those on London trust boards can take advantage of the King's Fund's London Board Leadership programme specifically for NEDs and chairs, which provides frequent talks and workshops on a wide range of issues to help them understand the policy context. They are also an opportunity for NEDs to talk to each other about issues that come up and form their own networks, says Dr Steward. Unfortunately, similar programmes are patchy around the country, but are supposed to be in development by SHAs, she adds.
On top of the commitment of two to three days a month for NEDs and a couple of days a week for chairs, they should also be aware of the time needed to familiarise themselves with the local policy context and what it means to be a NED in an NHS trust, she adds.
"The bottom line is NEDs need to understand the role of the board and the role of governance and their role in holding the trust to account. They need to be independent, they need to be confident and get by without excessive amounts of information and to get their point across," she concludes.