Non-executive directors bring unique knowledge and experiences to the boards they serve on. By overlooking this, NHS organisations are missing an opportunity for adding grit and aiding transformation, says Sam Milbank

With commercialism seeded and spreading across the NHS, boards are under pressure to get to grips with competition and choice and to ensure firm control over clinical risk and financial balance.

Most boards recognise this need and all are committed to briefing executive and non-executive members on NHS reforms, culture and complexities.

Secret weapon

The calibre and experience of NEDs in NHS organisations has improved noticeably with the increase in foundation trusts and the reconfigurations of 2006. Their skills and expertise are formidable, and yet the NHS risks not realising the value of this resource and using it to drive transformation. So why isn't this talent making itself heard?

For the NHS, choice and competition are relatively new concepts. And while financial balance and achieving top down targets are well understood, achieving a real return on investment rather than just a year-on-year surplus is regarded with caution. Many NHS organisations have tried to place all risks with partners, particularly those from the private sector, rather than really understanding and taking on shared commercial risk.

But these things are the bread and butter of many NEDs' day jobs. They have real experience of market-driven strategy, investments and disinvestment - all of which are as relevant to a national service industry as to their own businesses.

Being heard

The new breed of NEDs know and live experiences that drive excellent service - from the world of international corporate banking and advertising to consumer-based financial services - and yet the NHS does not hungrily demand that they use this experience to lead cultural change.

A good first step in overcoming this would be to create links between NEDs' consumer-driven commercial sectors and the NHS in order to share this experience. A second might be to create a duty on NHS employees to report all poor NHS service and for their comments to be taken seriously and used to drive change.

So come on NEDs, get yourselves heard and lift the NHS beyond its process fixation and into world class excellence.

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