Final Report > Chapter 24: A Health Service which is Well Led > The leadership and management of the NHS > The trust board

The trust board

31 Leadership at the local level also depends on the trust board. The board consists of executive and non-executive directors. As regards the executive directors, in particular the medical and nursing directors, it is of crucial importance that appointments are based on real ability and commitment to leadership and management. Trusts should make training and preparation for the role of executive Director part of their overall strategy and seek to identify and support those who may be suitable for appointment. The NHS Leadership Centre, in conjunction with trusts, should develop programmes of training and support for clinicians and others who seek to become executive directors. The criteria and process for selection must be clear and open. Appointments must be made on the basis of ability. They must not be made on some notion of `muggins' turn'. In one of our Seminars Hugo Mascie-Tayor pointed to the tendency to appoint the most senior consultant to the role of manager, and remarked that seniority does not necessarily guarantee managerial ability: `In some cases the most senior consultants were actually those least likely to take a corporate view, and making them the manager simply allowed them to exercise their individualistic powers more easily.' [10] And, just as there must be a clear process for appointment, so there must be systems to support executive directors while in office and to review, periodically, their peformance.

Footnotes

[10] Seminar 4. Dr Hugo Mascie-Taylor. Position Paper