Being Effective - What NHS Non-Executive Directors Need to Know

Introduction

Policy context

NHSScotland is driven by a wide range of policy initiatives, underpinned by The Healthcare Quality Strategy for NHSScotland (2010) and the Route Map to the 2020 Vision, published in 2013 (referred to as the 2020 Vision). The Healthcare Quality Strategy for NHSScotland was launched to continuously improve healthcare services for the population by delivering world-leading, safe, person-centred and effective care.

The 2020 Vision recognises the challenges and demands health and social care will face over the coming years and sets out how they will be addressed. It describes priority areas for action across three domains – quality of care experience, population health and equity, and value and financial sustainability. We refer to these as our ‘Triple Aim’ (Scottish Government, 2013), each domain of which has defined priority areas for action that often build on existing work. It is important that all Non-Executive Directors are clear on the triple aim approach that has been adopted and their role in ensuring delivery is within the remit of their Health Board and across NHSScotland. The Route Map is about retaining focus on improving quality and making measureable progress towards meeting the 2020 Vision aspirations.

Complementary to the 2020 Vision is Everyone Matters, the 2020 workforce vision. As the title suggests, this recognises the vital role each member of the NHS workforce plays in responding to the challenges the service faces. Everyone Matters sets out values that are shared across NHSScotland and asks all staff members to sign up to and reflect them in their everyday practice.

These key initiatives drive our quality, improvement and performance management structures.

The Scottish Government published a Clinical and Care Governance Framework for integrated health and social care services in December 2014. This framework outlines the roles, responsibilities and focus required by Integrated Joint Boards responsible for the delivery of integrated health and social care services in Scotland.

The NHS Board Chairs Quality Portfolio Group have agreed that it is essential to ensure that all NHS Boards have clear, transparent and robust local arrangements that demonstrate good governance. It is recognised and acknowledged that there are a wide range of existing resources and materials available to support the implementation of effective governance. This also requires effective oversight and integration of all governance strands.

The clinical and care governance sections of Integration Schemes for health and social care have been reviewed to identify areas where implementation support should be targeted. Further implementation support resources will be developed collaboratively with staff and be designed to take account of learning from reviews and reports from within NHSScotland (e.g. Healthcare Improvement Scotland reviews of NHS Lanarkshire and NHS Grampian and reports from other healthcare systems e.g. the Morecambe Bay Inquiry Report.

Purpose of NHS Boards

The overall purpose of the Board is to govern effectively and in doing so build patient, public and stakeholder confidence that their health and health care is in safe hands, accountability to the public and stakeholders is delivered by building confidence:

• in the quality and safety of health services;

• that resources are invested in a way that delivers optimal health outcomes and value;

• in the accessibility and responsiveness of health services; and

• that patients and the public can help to shape health services to meet their needs.

Roles of NHS Boards

Three main roles of NHS Boards as a Board of governance are:

• formulating strategy;

• ensuring accountability (including financial stewardship); and

• shaping a healthy culture for the Board and the organisation.

Adapted from On Board: a guide for board members of public bodies in Scotland, 2015, Scottish Government

NHS Boards are responsible for ensuring that the body delivers its functions in accordance with Scottish Ministers’ policies and priorities. This involves formulating strategy and setting out the strategic vision and purpose of the organisation. They hold the Executive to account for the delivery of strategy and ensure value for money. NHS Boards are also responsible for assuring that risks are managed and mitigated effectively. They are composed of a mixture of both Executive and Non-Executive Directors and have a collective responsibility for the performance of the organisation.

Roles of Board members

The table below illustrates the different roles of members of the Board.

	Chair	Chief Executive	Non-Executive	Executive
Formulate Strategy	Ensures Board develops vision, strategies and clear objectives to deliver organisational purpose	Leads strategy development process	Brings independent oversight, external perspectives, skills, and challenge to strategy development	Takes lead role in developing strategic proposals – drawing on professional and clinical expertise (where relevant)
Ensure Accountability	Makes sure the Board understands its own accountability for governing the organisation Ensures Board committees that support accountability are properly constituted Holds CE to account for delivery of strategy Leads the Board in being accountable to Scottish Ministers	Leads in the delivery of strategy Establishes effective performance management arrangements and controls Acts as Accountable Officer	Holds the Executive to account for the delivery of strategy Offers purposeful, constructive scrutiny and challenge Chairs or participates as a member of key committees that support accountability Account individually and collectively for the effectiveness of the Board	Leads implementation of strategy within functional areas Manages performance within their area and deals effectively with poor performance
Shape Culture	Provides visible leadership in developing a health culture for the organisation, and ensures that this is reflected and modelled in their own and in the Board’s behaviour and decision- making	Provides visible leadership in developing a health culture for the organisation, and ensures that this is reflected in their own and in the Executive’s behaviour and decision-making	Actively supports and promotes a healthy culture for the organisation and reflects this in their own behaviour Provides visible leadership in developing a health culture so that staff believe Non-Executives provide a safe point of access to the Board for raising concerns	Actively supports and promotes a positive culture of the organisation and reflects this in their own behaviour Nurtures good leadership at all levels, actively addressing problems impacting staff’s ability to do a good job
Intelligence	Ensures requirements for accurate, timely and clear information to Board are clear to the Executive	Ensures provision of accurate, timely and clear information to the Board	Satisfies themselves of the integrity of financial and quality intelligence including getting out and about, observing and talking to staff and patients	Takes principal responsibility for providing accurate timely and clear information to the Board
Engagement	Plays key role as ambassador and building strong partnerships with patients and public, staff, other stakeholders	Plays key leadership role in effective communication and building strong partnerships with patients, public, staff, stakeholders	Ensures Board acts in best interests of patients and public	Leads on engagement with specific internal or external stakeholder groups

Adapted from ‘The Healthy NHS Board’, 2013, NHS Leadership Academy

Knowledge and skills

Appointed by Scottish Ministers, all Non-Executive Directors play an integral role in the governance of the delivery of healthcare services to the people of Scotland. As such, in order to carry out their role effectively, all Non-Executive Directors need to have good understanding of:

• Scottish Ministers, Scottish Government and NHS policies and priorities;

• good governance;

• quality; and

• data measurement and improvement science.

They should also be able to:

• analyse and review complex information;

• weigh up conflicting issues, make decisions;

• question and challenge information constructively;

• participate and chair committees of the Health Board; and

• communicate confidently with stakeholders.

Being effective

This resource looks at the role of the Non-Executive Director and sets out some key questions that Non-Executive Directors of NHS Boards can ask to reassure themselves that they are ‘being effective’ in their role.

Each section contains ‘further information’ which contains links to a range of additional resources for those who wish to further develop their knowledge and skills. A complete table of resources can be found on page 25.

Further information

The Scottish Government website
http://www.gov.scot and the health and social care section is found at http://www.gov.scot/Topics/Health

Other useful reading materials include:

Governance for Quality Healthcare in Scotland: An Agreement, NHSScotland

On Board, a guide for board members of public bodies in Scotland, 2015, Scottish Government,

7 Principles of public life, 1995

The Good Governance Standard for Public Services, 2004
The Independent Commission on Good Governance in Public Services.

The Healthy NHS Board 2013 Principles for Good Governance, NHS Leadership Academy