It’s funny how you can sometimes get a gut feel about things.
I’ve got one…
I get a sense that there is something seriously wrong with the NHSE/I Board, particularly the non-execs.
I know I’ve mentioned it a couple of times. It seems to me they’ve lost the plot.
For once, it’s not the money. I think there’s a political understanding that Covid cost a lot and clearing up after Covid is going to cost a lot more.
I get no awareness around the serious state of the workforce, nor the warnings that Covid related staff absences are going up. They rose by 56% last week.
The new GP contract has landed badly.
The new faces at the BMA look ready for a fight.
MH services are having an almighty struggle.
There are 800, newly qualified doctors running around the system, with no placements for them to go to.
These are all strategic issues for the Board.
There are three things that might be happening…
… the Board are just ‘out-of-the-loop’ and are rubber-stamping whatever comes across from the DH, to the executive.
The powers the Covid regulations gave the SoS are seductive and No19 doesn’t look likely to give them up in a hurry. Indeed, the new Health Bill gives him a greater grip.
… they are overwhelmed by the challenges. Nothing in their background or careers will have prepared them for what the last couple of years has thrown at them and what is to come during a prolonged recovery. Or…
… they are just not very good.
Whichever one of the three it is, it’s OK.
If it’s the first, they need to figure out just what the new relationship with the SoS is going to be.
If the DH+ is going to make the strategic decisions and the NHSE board become Deliveroo… figure out how to manage that?
If they are overwhelmed, they could be honest and look for a way to move up a gear, or move out.
If they are out of their depth, and that is what it’s increasingly looking like, they should ‘do the right thing’.
The Institute of Directors say, the role of the Board is;
‘… to ensure the company’s prosperity by collectively directing the company’s affairs while meeting the appropriate interests of its shareholders and relevant stakeholders…’
In NHS speak that might translate as;
‘… to ensure the NHS is resourced and planned to enable them to collectively direct its affairs, to meet the appropriate interests of the public and the people working in it.’
Put another way…
...it’s the Board’s job to assess and monitor the organisation’s ‘ambition’ and identify where policies, procedures and promises do not align with the reality of the situation and then create deliverable plans in an honest and transparent way.
When directors are energised, understand the issues and are productive… it shows.
Watching the NHSE Board at their January public meeting tells me; all is not well…. because it shows.
The finance report was delivered in about 45 seconds and there were no questions from the Board.
They either: didn’t understand it; aren’t interested; or been told to shut up.
What can a Board do when it loses its way? Four things;
- Take time to refocus on its mission – what is it trying to achieve? An externally facilitated away-time, maybe?
- Answer the question; how are we doing? Bring in a third party board-evaluations-team, such as the Civil Service College.
- Refresh the membership. This has been a tough time for every one. Is it time for fresh faces and new thoughts?
- Reconnect with the organisation by spending time, in the organisation…
… for instance, the Board must realise, what the world and his wife realise…
- There are not going to be 40 new hospitals, they should say so.
- There are not going to be 50,000 new nurses, they should say so.
- There are not going to be significantly more medical staff any time soon and they should say so.
And, the lack of diversity at the top sends the wrong message to the rest of the NHS.
This is a poor Board, performing poorly.
My guess… they’ve had the stuffing knocked out of them and there is no leadership to revitalise them. And…
… it’s obvious. The real problem. The DH+ is running the NHS. The Board is a Board in name only… and they’ve lost interest.
…more puppets than a toy shop.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
