what works

Q I am involved with acute colleagues in negotiating commissioning with local primary care trusts.Some of the PCT 'side of the table'used to work here a few years ago and were junior to 'this side of the table'. I think the past relationship is overshadowing meetings, with some people still in 'master-servant' roles and some going too far the other way to show that It is all behind them.

A Most of us find if difficult to get ourselves out of relationships formed in previous roles and to see people in their new ones. It is very important to be able to see people as they are and not as they were. Over-compensation is also unhelpful. It would be a good idea to tactfully challenge your colleagues and to ask them whether they are aware of the attitudes they are displaying. Try to get them to think about their PCT colleagues as though they had never worked with them before.

Underlying the personal relationship issues you raise is the whole question of the organisational relationship between PCTs and acute trusts. PCTs have been given the very difficult task of using the resources of the NHS in the best interests of their local people.

Anyone who thinks about this will realise very rapidly that it is not a simple business. It is easy enough to criticise PCT decisions but if acute trusts had to make decisions about the competing needs of all sections of the population, would they make better decisions? It is only fair to remember that most PCTs are only two years old and most acute trusts are at least 10 years old.

It takes time to establish new organisations - it is not something that can be done overnight.

Q Our non-executive team is getting too cosy and inward-looking.Members do not treat decisions with rigour, do not ask awkward questions and too often deal with things at a personal level.The problem is the top manager team seems quite happy.

A Many non-executives find if difficult to strike the right balance between challenge and support. Executives need support in dealing with the many challenges they face.However, non-executives are there to represent the public interest and to ensure that executives do their job.

Many executives are understandably grateful for the support and do not worry about the public accountability. It is good that some executives, like you, are alive to the dangers of too cosy a relationship.

The best approach to the problem is to refresh your board development programme.Make sure that seminars provide the opportunity for in-depth discussion of issues in an informal atmosphere where challenge is more likely to be present. See if you can get some outside speakers to test the way you are approaching things.

Persuade the chair and chief executive to ask a skilled organisational development/governance consultant to spend some time with the board individually and collectively and feed back at a development event.

Ken Jarrold is chief executive of County Durham and Tees Valley strategic health authority.We are offering every reader who has a query printed a free copy of our highly popular management toolkit Leadership at Every Level , worth£95.E-mail your query in confidence to nick. edwards@emap. com marked Dear Ken.