NHS boards' composition must reflect not just the community but the changing needs of the service itself, says Robina Shah

It is very humbling when the contribution made by chairs and non-executive directors to the NHS is recognised publicly.

At a national event for trust chairs in January, health secretary Alan Johnson thanked all of us for our valued and continued commitment to the NHS. He said: "You in this audience are talented people with vast experience outside the NHS and, like me, you come to the NHS in the main with a fresh perspective. I am enormously grateful for the work you do."

It is nice to be appreciated, but it is also true that when there is evidence of poor practice, poor leadership and poor patient care, the very same non-executive community can be left feeling sore and vulnerable. This often stems from a lack of opportunity to have a voice that is heard in the same public domain in which the performance of boards is being judged.

It is appropriate to have full exposure when things go wrong; after all, boards are accountable to the public they serve and we all have a duty of care to our patients, staff and the community. However, the attention being given to boards when things are going wrong can be disproportionate to the majority of cases when things are going right.

Constant spotlight

There is also a deep-rooted problem of NHS boards, chairs and their non-executive directors being treated as a homogenous group and without any individual identity. The composition of the NHS trust board at national, regional or local levels is diverse and heterogeneous. Each provides a narrative, which is unique to its constituents.

In fact, we jealously guard that uniqueness and yet we are able to blend our personalities to ensure delivery of national targets and a patient experience which feels individual to them.

The spotlight is constantly on us, we are conscious of our responsibility to deliver high quality, safe, inclusive and accessible health and social care services.

We are also fully aware of the diverse skills, knowledge and experience that non-executives bring to the role.

Chairs in particular have a duty to ensure they have an engaged board that works to blend the competencies, skills and knowledge that the non-executive directors bring, while at the same time leading the board to deliver its corporate responsibilities as a collective team.

Major impact

However, the NHS landscape is constantly in flux and it is important that the composition of the board is relevant, appropriate and able to meet the challenges that a world class NHS will require.

This scenario, described here candidly by one trust chair, is a familiar one: "In preparation for the new world we now inhabit, I felt that the board I inherited was simply not up to the job. The new commercial reality requires people with business and commercial skills, not the former social workers and health administrators that have been adequate in the past".

Undeterred, the same chair made the changes necessary by following due process. "I used the appraisal system to set new objectives for the non-executive team and made it clear that they should accept responsibility for the previous failures. This did not go down well and I experienced some real pressure from non-executive directors, who thought it might be easier to get rid of me rather than try to adapt to the changed environment.

"Two years on, I have a really great board, with a substantial change in personnel. My new board has some impressive financial, marketing, commercial and PR expertise and is beginning to make a major impact."

I invite you to participate in Board Talk, a new section on hsj.co.uk for the non-executive community (see below). It will seek to identify common themes experienced by some trusts and discuss them in open debate. It will also offer the opportunity to share best practice and help navigate the NHS sea together.

Board Talk

Board Talk is a new area on hsj.co.uk for the non-executive community. With regular news, articles and columnists, Board Talk is completely free once you have registered with the website.