Considering becoming an NHS NED or just joined? 10 things to consider...

25 July 2017


The NHS remains a challenging sector in which to work. Financially constrained with increasing demand but with huge opportunity to bring in new levels of cooperation through place based care and innovative technology enabled care. NHS non-executive directors can play a key role in the drive for efficiency and for system and technological change.  

PwC is in the second year of working with NHS NEDs to support them in this key role and to develop their skills and knowledge. Through an extensive programme of events, covering a myriad of topics from turnaround to cyber, we have brought together sector experts to share information and best practice. Through our conversations we have learnt much about what’s important to NEDs and how they do their jobs. The feedback we have had on the programme has been very encouraging.

“Very valuable for a relatively new NED to gain insights into system wide issues and compare insights and experiences with other NEDs.” NED, Surrey

“Excellent programme - really helpful in changing mind-sets.” NED, Devon

Based on our conversations with NEDs and understanding better their experience in the NHS we have developed a list of tips for those people considering or embarking on a new NHS NED role.

  1. Check your suitability - before accepting or applying for a post check your suitability for the role - do your own due diligence on the organisation and what’s expected from you and think about what you can add. Speak to others who have carried out a similar role. Work out if your unique skills will add value and if you have sufficient time to dedicate to the role. You don’t need specific health sector experience - we all use the NHS as do our families and friends.

  2. Know your colleagues - get to know your colleagues on the Board, in particular the Chair, and understand their particular skill sets and backgrounds. Similarly, acquaint yourself with the people you will have most dealings with from within the organisation itself, even spending time with them to understand how they go about their daily jobs and the issues they are facing.

  3. Understand your organisation - get under the skin of how the organisation works and what it is aiming to achieve. Meet the staff and observe daily working as well as meeting some external  stakeholders - an outside view is always important to bring to the mix. Go ‘off piste’ during scripted NEDs visits to get a real feel for the organisation and its culture. Remember the patient too - try and put yourself in their shoes. Make sure you understand who the key stakeholders are as well as your Board colleagues such as governors, members of the trust, patients, medical staff, nursing staff. In addition, understanding the financial condition of the trust is key as well as the results of recent reviews e.g. CQC - this will help you judge the scale of the challenges it faces. This will also impact how much time a NED might be expected to devote to the trust, which is an important consideration in its own right.

  4. Be aware of the wider environment and importance of working in the wider local health and care system - healthcare organisations are impacted by decisions that are taken by both national and local bodies. It’s important to understand the detail of the regulatory environment while also having a handle on the broader politics. The Five Year Forward View is essential reading. Increasingly NEDs have to serve one organisation but play a role in enabling constructive relationships with other organisations in the wider health system so understanding local issues is key.

  5. Be involved in shaping strategy - Board members are well placed to support the organisation's broader strategy. This does not need to be worded in business school jargon. A clear articulation is needed of where the organisation is trying to go and how it thinks it can get there. The Board is key to monitoring the progress of the strategy against key indicators and milestones whilst being alert to likely technological/other disruptors.

  6. Understand resource allocation - ensure a full understanding of how resources relate to the strategy and be prepared to support the organisation in making difficult decisions. Expect to support the CEO and other execs in communicating the decisions.

  7. Step up - Board members should be visible when the organisation needs support on dealing with issues as well as when there is good news to promote . Being a CEO or Executive Director can be a lonely, thankless role and sharing some of the burden can only be a good thing.

  8. Draw on your experience and keep up to date - ideas from other sectors should be welcomed and don’t be afraid to bring a business mind to a public body. Disruption and new technology are key to transforming the healthcare system to bring about more effective use of resources and better patient outcomes. Outside the box thinking will be more than welcomed. Don't be deterred by the NHS orthodoxies and claims that it won't work here.

  9. Be prepared to question - don’t take anything for granted. Support the exec team in making sure they have considered all the options and looked at issues in the round. Use the Board to sound out new initiatives and ideas. Remain alert to the key risks the organisation is facing and ensure appropriate controls are in place to mitigate these.

  10. Champion - speak up for your organisation externally and help to promote appropriate values and standards internally. Make sure you know the stats on patient satisfaction, operations performed, patients through the door etc. There is a great story to tell about the NHS - even in these challenging times.

PwC has recently launched the next  programme of events for NHS NEDs - June 2017 - February 2018. Read about the events and register here.

Quentin Cole | Partner, UK Health Industries Leader
Email | +44 (0)20 721 26784

View Quentin's profile on LinkedIn