Delivering strategic transformation - the changing role of the NHS Chair

11 April 2018

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For the last couple of years, I have been chair of a relatively small mental health trust in Staffordshire, but my background is very much in the private sector, as non-executive chair of a series of corporations dealing with acute financial pressure.

Even in my limited time in the NHS, long established structures have been changing dramatically and the role of a chair is certainly not what it was. Not long ago, trusts were fairly stable things and not much changed from one year to the next. The chair had responsibilities which were largely internal to the trust, focussed on sustaining a positive and supportive culture. The imperfect internal market meant that trusts had to compete from time to time for commissioned work, and the NHS superstructure was overhauled frequently, but for a trust chair, change was not a big issue.

But things have changed. We are now working in a system under pressure – all sorts of pressure: financial, workforce, regulatory and political. When that happens, horizons are foreshortened and strategy is replaced by short-term tactical behaviour. Central to the chair’s role in this new environment is, therefore, to sustain strategic thinking, to keep a focus on that point on the horizon towards which we strive even while the big waves threaten us from every side.

And the internal market is fast disappearing. Collaboration is the name of the game. That change demands a different cultural approach and the chair is the person responsible for bringing that change about. Not easy: dinosaurs abound and relationships are challenged.

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In the new age, transformation is the only way to sustainability. And the currency of transformation is trust. Trust between collaborating organisations to best serve a local population. Trust does not just happen – it has to be generated by contact, by respect and by understanding. Again, chairs are central to this process. At least half of my time is spent outside of my trust, attending the board meetings of partner organisations and gaining understanding of their problems and priorities. The process can be more challenging when the partners are local authorities, with their complex structures and different financial imperatives.

Then there is the process of transformation itself. Participation in STPs and their many delivery vehicles demands more and more time and commitment. Chairs have a key role to smooth the way when disagreements stall progress.

And all the time there is regulatory pressure – chairs as well as chief execs get summoned to London to explain missed targets and to be pressured into making new promises.

It is not the job it was. It is not for the squeamish. It is demanding and time consuming. But with the stress also comes an enormous sense of worth, of making a difference, and of admiring the warmth and the skills of those with whom the challenges are faced. I am enjoying every day of it.

It has been invaluable to me to meet other NHS NEDs and to hear from experts across the sector at PwC’s NHS NEDs events. I would encourage anyone who is doing the job to sign up to events and have the chance to explore, learn and engage on key issues of the day.

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