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The NHS Non- Executive in Times of Crisis

Finding or maintaining meaning and value during these extraordinary times is a preoccupation for us all. For the Non-Executive community working within the NHS this challenge is prescient. As we speak the NHS has reverted to a command and control mode, where the priorities are for each NHS organisation to act as a part of the whole. As Non-Executive Directors one becomes used to dealing with extraordinary events, but may be less prepared when facing these extraordinary times. Agility, flexibility and focus will therefore be central to ensuring that Non-Executives are able to support the now as well as to help frame the afterwards.

Immediate Priorities

At the collective level it will be important for the Board to maintain the formalities of good governance, but to execute these in a manner that is focussed on supporting the short term imperatives, whilst ensuring that wider organisational learning can take place. In writing this piece I reflected on one particular occasion when as Chair of a London NHS Trust, we were collectively required to respond to an extraordinary event of elder abuse against a patient.

Management of the situation look the Board outside of its comfort zone, requiring an accelerated speed of response, an enhanced awareness of the external environment and cognisance of the need for systemic learning. Then as now with Covid 19, the focus was on the operational, with the value and necessity of good governance less evident. Yet at times of crisis Boards are an important formal mechanism to support the organisation and to hold the Executive to account. Asking the right question in the right way and at the right time, the Non-Executive Director has the potential to add game changing value.

I also noticed was when the Executive Team was rightly focussed on the internal, the Non-Executive could act as a conduit for effective external communication, whilst the application of soft skills at such times of acute stress also added significant value. Shock manifests in multifaceted ways and I witnessed how Non-Executives helped to manage this through mentorship, coaching or just the old fashioned ability to listen.

Framing Afterwards

Experience has also taught me that the Non-Executive holds that precious ability to take one step back and in doing so can help to provide a means to frame both the present and the future. One of the roles that the Non-Executive can usefully play at this point is to begin to reflect on governance resilience. It strikes me now for instance to remember that in the late 1990s our Board periodically considered the issue of organisational and health system risk management. The risk of a pandemic ranked highly even then, but I now ask myself whether the Board was enabled to engage with the issue in a sufficiently robust manner?

Valuing Virtual Communication

A final reflection is that the non-executive today faces these challenges with the additional hurdle of having to work within a virtual space  Virtual communication is evolving in real time with volume, form and value increasing as it becomes the principal means of exchange, rather than it being a sub-optimal adjunct.  Non-executives can play their part in ensuring that Board governance by taking time out to reflect on how they can improve their engagement. At a basic level this means ensuring that you are able to connect in a manner that does not allow the technology to be a physical barrier and beyond this the Non-Executive can reflect on how to engage most effectively on-line. But again with one eye on afterwards, is this not a good time to think more broadly about Board governance and communication?

Final Thoughts

There has been significant global variation in health system response to Covid 19, with preparedness and response generally stronger in Eastern countries to those in the West. This is leaving systems such as the NHS facing unprecedented levels of need and risk. The NHS will undergo change as a result of its experience of dealing with this, the most significant challenge it has faced since inception in 1948.

The role of the NHS Board and its non-executive director resource will be instrumental in helping to both inform and react to what is likely to be a challenging future. They are also likely to require support in helping to develop more resilient and robust systems of Governance and the work of organisations such as the Good Governance Institute is likely to be vital in ensuring supporting such efforts.

This blog was first posted on the Good Governance Institute website, where you can find useful content relating to Covid 19 as well as more general material on effective health system governance https://www.good-governance.org.uk/covid-19/

Team Remain, Brexit and the urgent need for a Plan B

As someone who firmly believes in Europe and the UK’s membership of the European Union, I feel that whatever the outcome of the vote on June 23rd my fellow Remain campaigners have not played their hand well and that the price for this maybe exacting.

Firstly, I believe that Team Remain have been dismissive of the core arguments of the Brexit camp, caricaturing them as playing to a simplistic and toxic combination of nationalism, economic insecurity and a distrust of political elites. Yet to my mind the very essence of that simplicity, fanned as it has been by the cursory dismissals of the metropolitan elite has generated a bonfire of resentment that is at risk of becoming a firestorm of dissent.

Secondly, the Remain camp armed with what they profoundly believe to be an unparalleled arsenal of ‘facts’ has resorted to carpet bombing the opposition with little thought for potential collateral damage. This in turn appears to have only succeeded in creating a Dunkirk spirit in many of the English towns and much of its countryside, although not to date in the nation’s Capital nor in much of Scotland, Wales and Northern Ireland.

Yet whilst the dogs of war analogy may help to explain why the Remain campaign is currently at risk of losing a battle many feel it should have already won, for me it is the analogy of the failing marriage rather than the military campaign that I believe may better help us Remain campaigners to regain much needed momentum.

I see the Brexit camp as representing the partner who believes that they have grown out of a marriage or perhaps that they should never have taken the plunge in the first place. To them the path forward is clear, make a break and move on. In their minds both parties can be persuaded round to an amicable settlement, where assets will be divided and visitation rights agreed. Why in time, when each partner has perhaps remarried, there could even be the possibility to meet occasionally for meals or even take a joint holiday.

The problem with this idea is that in this particular relationship the other partner does not want a divorce and doesn’t actually think there is that much wrong with the marriage in the first place. Not only that, but whilst they have been willing to do an initial bit of give and take, they would not respond well to their spouse simply packing their bags and leaving. Europe would not leave the family home quietly, first dragging its feet and arguing over ownership of every last photo and CD but then stretching the analogy a little further arguing over custody of the children and perhaps even the granting of parental visiting rights. I am not even sure they would agree to sell the family home.

So whilst in time the UK could use a clean divorce to go out a bit more and make new friends, perhaps even to re-marry, would it not be even more likely that matters could just fester, leaving both Europe and the UK the worse off. Whilst I would not be old fashioned enough to argue that marriage is always for life or that divorce can not provide a much needed means to start over, the potential benefits of a strong relationship built on mutual respect and understanding still hold. Neither partner should dominate, nor should the independent element of their respective lives be undervalued, but the value of being a partnership remains. Oh and one thing I am sure of is that if the UK does decide to walk out of this marriage then it wont be quick and it wont be pleasant.

Crisis what Crisis? The National Health Service, notions of health resilience and the 2015 General Election

With the UK Election drawing to a close the future of the National Health Service remains centre stage. With talk of a system in crisis the political rhetoric has been turned up to eleven, with accusation and counter accusation flying across the political divide. Little wonder given that the latest Ipsos Mori poll finds the NHS to be one of the most important issues for the British electorate, particularly for undecided voters . Is talk of a crisis correct and if evidence does point to a system in peril are politicians using their current electoral platform to forward sustainable solutions, solutions that incorporate for instance emerging thinking on the development of community and individual health resilience? Read More »

Why did the chlorinated chicken cross the road?

As European families celebrate the festive period with roast duck, goose, turkey or chicken how many realise that two out of three of their meals may contain dangerously high levels of bacteria? How does this sit alongside the view from many civil society organisations that current negotiations between the United States and the European Union could lead Europe to lower its food standards, as restrictions are lifted on banned foodstuffs including chlorinated chicken – the bête noire of European food safety? Read More »

Why is the NHS still so important to the British?

As Ed Miliband unveils his plan at this years Labour Party Conference to introduce a mansion tax to help ‘save the NHS’, I am led to ask the question “Why is the NHS still so important to the British people?” I believe that the question can be answered by considering what the NHS is and what the NHS does, but that it is even more revealing to look below the surface and to consider the enduring values that the NHS continues to represent. Read More »

Scottish Independence, minimum alcohol pricing and the challenge of national self-determination in a globalized world?

I was speaking at the European Public Health Alliance Annual Conference in Brussels last week and was lucky enough to be able to attend a fringe meeting on the introduction of minimum alcohol policy in Scotland. Making links to the upcoming vote on Scottish independence and the common desire for communities to set their own public health agendas, here is my blog on the subject.

The fever surrounding the upcoming Scottish independence vote will draw to a conclusion shortly with electors finally able to make their choice. The vote raises issues relating to identity, nationalism and self-determination that go well beyond the vital yet singular question of how the nations of Britain should be governed. But what I wanted to do in this Blog is to draw comparisons between the independence vote and the current attempt by the Scottish Government’s to introduce minimum alcohol pricing. The parallels are I believe quite striking. Read More »

Why is there so little evidence about evidence based policy making?

You maybe surprised to hear that we don’t actually know how many policies are based upon a systematic review of evidence or data, or perhaps even more surprising whether evidence based decision making is actually better than policy made on the hoof. Read More »

The Grit in the Oyster: Britain’s relationship with the European Union

The UK Government recently published the first of a two part rapid review of EU competencies which followed David Cameron’s January commitment to an ‘in-out’ referendum on Britain’s continued EU membership.

Reading the Summary Reports I was oddly reminded of a scene from the film The Last King of Scotland. Dr. Nicholas Garrigan a young Scottish doctor has found himself unwitting counsel to the Ugandan Dictator Idi Amin and is being asked why he didn’t advise him not to expel the Asian community from the country, with all the catastrophic consequences that followed. Garrigan responds by saying he did tell him, whereupon Amin bellows back to his face “Yes you did tell me, but you did not persuade me!” Read More »

Reflections from the other side of the pond

I have just had the pleasure of spending a week in London with a group of US academics who work in the field of Health Management. Time was spent visiting organisations across the capital, listening to health care managers, regulators, policy makers and analysts present on the ‘State of the NHS’.

The following are my ‘take away’ thoughts and reflections and in setting them out I would like to thanks my colleagues from the US for a truly stimulating few days and to colleagues from the NHS and beyond for their energy, enthusiasm and the time given to share their knowledge and experience. Read More »