Final Report > Chapter 24: A Health Service which is Well Led > The leadership and management of the NHS > Non-executive directors of trusts

Non-executive directors of trusts

32 As for the non-executive directors, a very clear message to emerge from Bristol is how readily the board's non-executive directors (and even to an extent the chairman) can be prevented from exerting the authority expected of them, simply by not being let in on issues. A strong chief executive, with support from executive directors, can seek to control what comes to the board and in what way. Once this approach takes hold, it is hard to overcome. Its consequence is that the board cannot effectively serve the public interest.

33 We were struck by the views expressed in our Seminars about the variation in the roles played by and the expectations held of non-executive directors. An overriding sense of lack of clarity and direction emerged. And, without sound knowledge of what might be happening in the trust, non-executive directors were often unable to challenge the views of the chief executive, or the executive directors. In our view, non-executive directors have a crucial role to play as representing the public interest in the conduct of the trust's affairs. They must be people with a high level of ability and experience in the leadership and management of organisations. They should not all have a background in healthcare, since the views in organisational terms of those with differing experience can be of great importance. They should, however, have a commitment to public service. Given the importance of their role, the process of appointment must be open and transparent. As recommended in `The NHS Plan', [11] there should be an NHS Appointments Commission responsible for the appointment of non-executive directors of trusts, health authorities and primary care trusts. The criteria for appointment must also be open and clear. We were pleased to note that `The NHS Plan' included a proposal to develop training for non-executive directors and to issue a standard job description. These are long overdue. There should also be a programme of induction which should refer to the principles and values of the NHS and the duties and responsibilities of non-executives with regard to the quality of care provided by the trust. This programme should be provided through the NHS Leadership Centre. The non-executive directors must be allowed to become thoroughly involved in the affairs of the trust. They must be let in and then assert the authority which is properly theirs. This is particulary so in the case of the Chairs of trust boards. They must be supported to exercise their authority and independence of mind, That is why we believe that the Chairs of trust boards should have a source of independent advice (or mentor) during their period in office drawn from a pool of experts assembled by the NHS Leadership Centre. We note here also, and endorse, the views expressed in a recent report from the Cabinet Office: that all non-executives members of boards in the public sector should receive suitable training, including best practice on recruitment, on performance management for leaders and on holding leaders to account. [12]

Footnotes

[11] `The NHS Plan'. London: Department of Health, 2000. Para 6.54

[12] Cabinet Office, Performance and Innovation Unit, `Strengthening Leadership in the Public Sector'. April 2001. www.cabinet-office.gov.uk