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