Annex A > Chapter 8 - Management and Culture of the UBH and the UBHT > The development of the clinical directorate structure > The role of the Trust Chairman
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The role of the Trust Chairman
203 In 1994 the NHS published the `Code of Accountability for NHS Boards'. [236] This described the Chairman's role thus:
`The chairman is responsible for leading the board and for ensuring that it successfully discharges its overall responsibility for the organisation as a whole.
`A complementary relationship between the chairman and the chief executive is important.' [237]
204 Mr Durie was Chairman of the B&WDHA from 1 April 1986 to 31 March 1990 and then Chairman of the UBHT from 1 April 1991 to 30 June 1994. In the period between his two chairmanships:
`... I was no longer involved with the National Health Service, except I think I had the title ... some funny title they dreamt up for people who helped work out applications for Trust status.' [238]
205 Thus, like Dr Roylance, Mrs Maisey and Mr Nix, in particular, his evidence straddles the management and culture at Bristol both before and after the inception of the UBHT. When Mr Durie took up his post as Chairman of the Health Authority the only guidance he received on what was expected of him was a briefing from his predecessor and a discussion with the Chairman of the RHA. [239]
206 Mr Durie, the first Chairman of the UBHT, described his view of the role:
`The Chairman's role was somewhat ill-defined, but my personal belief was that it was up to me to ensure that the hospital services under me provided the most effective healthcare to the greatest numbers within the financial limitations imposed. That said, as Chairman of the [B&WDHA] and latterly UBHT, I was keenly aware that it was not my function to take over from the full time executive or to provide parallel management. I saw myself more as Chairman first of the Health Authority and then of the Trust Board, responsible for ensuring that in addition to treating today's patients, there was the organisation and the management structure to prepare clear plans for the future. In so complex and diverse an organisation, I thought it important to be known personally and also to be seen as approachable.' [240]
207 Dr Roylance shared Mr Durie's view of the role of Chairman. Dr Roylance was asked:
`Would the Chairman of the Trust qualify as senior management?'
`No, he is not a manager at all. The Chairman and Non-Executives set policy and supported management, which was performed by the Executive Directors. There was no question about that ... the Trust Board set policy, and it was left to the managers to implement it. We were the managers. The Trust Board did not manage anything ... the Trust Board was a policy making body. I headed the management function to implement that policy. I did not expect the Trust Board to manage and they did not expect to.' [241]
208 Mr Robert McKinlay was Chairman of the Board from July 1994 to November 1996. He described the role in his written statement:
`... the Chairman is on the scene much more frequently than the other Directors, and he or she becomes the bridge between the Executive team and the Board. The Chairman needs to know what is going on to a greater degree than the other non-executive directors, in order to give on the spot advice to the Executive team and guide the deliberations of the Board. In addition, on many occasions the Chairman is required to be the representative or spokesman for the Trust.' [242]
`To implement the policy of the Chairman having a good understanding of what is going on, the Chairman should attend as many committee meetings as possible, which was my practice. In addition, there should be regular meetings with Executive Directors. I would meet the Chief Executive at least once per fortnight on a planned basis, when he would bring issues to my notice and vice versa. I would meet with the other Executive Directors individually on a planned basis every 4-6 weeks. In practice, by being around in the Trust and attending meetings, I would meet the Executive team and the other non-Executive Directors frequently.' [243]
210 To stay informed as to what was going on in the wider hospital community, Mr McKinlay paid:
`... regular visits to the various hospitals and services, both during the day and at night ... These visits were invaluable in seeing how the doctors, nurses and administrators were facing up to the day to day challenges, and to put into perspective proposals for change, either physical or operational, which the Board was being asked to consider.' [244]
211 Dr Thorne was asked what the role of the Chairman was as she understood it from her work at the UBHT. She replied:
`I think the role of the Chairman was to take a strategic overview and to manage the work of the Board effectively. I think that means actually managing the cohesion of the Board and actually looking at the competencies of the constitution of the Board, because that is inordinately important, having the right balance of people. I think that is a very important role for a Chairman to play, and I think it is also about actually being in some senses a figurehead whom people recognise as a symbol of a kind of strategic level, but are almost dissociated from the executive role because I also think that is important. So they have to ensure the non-executives do not try to become operational, because that is the road to disaster.' [245]
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Footnotes
[236] Department of Health, April 1994
[237] HOME 0004 0073 - 0074 ; `Code of Accountability for NHS Boards`
[240] WIT 0086 0002 Mr Durie
[242] WIT 0102 0006 Mr McKinlay
[243] WIT 0102 0008 Mr McKinlay
[244] WIT 0102 0008 Mr McKinlay