What’s the role of NEDs in the emerging health landscape?

01 December 2016

As individual NHS organisations wrestle with the conundrum of trying to operate in whole systems for the greater good, while having to protect and then defend their narrower organisational interests to regulators, the task of NEDs is becoming ever more challenging.  Indeed, it’s a role which tests even those Chairs and NEDs whose day jobs require them to work in the most complex of systems. 

Add to this, the perennial NHS board challenges of conducting their work in the glare of an increasingly unforgiving public spotlight. While the demands on NEDs are growing, there is often little by way of support.

Over the past year, PwC has been running a development programme, which I lead in my role as Chair of PwC’s Public Sector Health Board, supporting NEDs to play an effective governance role in their organisations and health systems.  The monthly workshops are free to attend and are specifically aimed at NEDs and Chairs in order to provide the opportunity to have detailed two way discussions with key national figures and leading Chairs, to gain insights simultaneously from the centre and the coalface about the challenges as they experience them. Over and above that they provide the chance to share best practice between themselves in terms of how each are making progress, whilst also giving people the opportunity, when feeling pressured, to 'huddle together for warmth!'

Topics we’ve explored through the NEDs programme have included issues such as dealing with conflicting regulatory pressures, marrying institutional and system wide interests in Sustainability and Transformation Plans (STPs), going from turnaround to transformation, and building new provider alliances.  But a number of overarching messages have emerged in terms of how NEDs can operate effectively today and in future:

Firstly, when seeking solutions to the challenges they’re confronted with, NEDs should focus on change, not cash.  While a surprise injection of funding would be welcome in many quarters of today’s NHS, NEDs need to focus on those changes and reforms they have the power to drive locally.

Secondly, it’s up to NEDs to be leaders of their local organisations and systems. Too often leaders across the NHS look up to the centre for answers or pointers for the way forward: NEDs need to resist becoming passive followers and lead the change that needs to happen across the services.

Thirdly, and relatedly, instead of looking up, NEDs need to make time for looking out, namely towards the communities and public that they serve. This will be a challenging change for NEDs who have traditionally played very much internal roles, but with difficult decisions ahead on the future shape of the health service, engaging the public will be critical.

Fourth, it’s time for NEDs to think systems, not institutions. While NEDs will have obligations and ties towards their individual organisations, they need to think about how their organisation impacts the system as a whole.  Simple ideas that were suggested at a recent NED event included having regular meetings of NEDs from across all organisations involved in an STP.

Finally, the answers for the NHS will be found by focusing on the future, rather than looking to the past.  Harnessing technology has the potential to transform how health services are delivered and how the public is engaged to become active participants in their own health and care.

There is much here for hard working and hard pressed NEDs but critically there is a recognition of the vital work they do and the critical work they have that lies ahead.

For further details on the PwC NHS NEDs programme contact healthneds@uk.pwc.com.

Mike Farrar, Chair of PwC's Public Sector Health Board
Email Mike Farrar

Tel: +44 (0) 20 7804 4019

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