As chair of Birmingham Children's Hospital foundation trust, I had a unique role in our bid for FT status. It was my job to develop the board and guide it through the rigorous application process.

So were we successful? Yes, immensely so. But only after a lot of hard work and more than a little pain. The trust's license was granted on 1 February 2007, a year ahead of all predictions.

The process of becoming a foundation trust is challenging and relentless, with scrutiny of current and future financial and operational performance. My role was to lead and develop the board, but what did this actually mean for us?

I found my business experience invaluable in my preparations for foundation trust status, particularly in relation to the focus on profit, cash flow and working capital.


First, I reviewed the skill mix of the non-executive directors and initiated some changes. I recruited two new NEDs to complement the chartered accountant, regional banker and market researcher we already had. Our new recruits were a family lawyer and the dean of the medical school of one of the local universities.

I resisted giving in to the "Monitor myth" that boards should have an NED from every professional body and instead decided that added value and complementary styles were more important.

I deliberately left one vacancy open throughout the process, which gave me time to identify skills we would need after getting FT status. Although Monitor challenged this decision, it accepted my reasons. I am now benefiting from the decision, as we have been able to be more specific about the skills required in the latest round of NED recruitment.


With the support of the company secretary, I reviewed our corporate governance structure. First, I took part in an Institute of Directors programme on the role of the company chairman. I wanted to be sure our governance would stand up to scrutiny and serve us well in an FT.

After examining the function, terms of reference and membership of the sub-committees of the board, I redefined the committees, redrew the membership, rewrote the terms of reference, checked out NED understanding of roles and revisited the meaning of "delegated responsibility".

Together with the chief executive, I committed the board to a review of its performance and set it on a programme focused on learning more about individual strengths and how to maximise them. We identified skill gaps and worked collectively to smooth out some weaknesses. Focused "teach-in" sessions on relevant topics ran alongside the development of the board's corporate competence.

In addition, we each benefited from some individual coaching sessions provided by a consultant.

Board to board

We prepared extensively for Monitor's "board to board" challenge. I devised a plan to allow us to support each other at the event. We were individually briefed on the trust's current position and forecasts and we had a first and second in line to answer every area of potential questioning.

Although we were relieved when the event was over, we felt we were able to deal with the challenge. I am convinced this was because of the investment we had made in each other and in developing as a cohesive team. It was a day the board will never forget, as it was also the day the first patient was admitted to our new£19m burns, education and neonatal centre.

While we remained focused on success throughout the application process, we were all convinced we were a better team as a result of it, whatever the outcome.