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

Ensuring Accountability

The second role of the Board is to ensure accountability by:

• holding the Executive to account for delivery of strategy and performance of the organisation;

• being accountable for ensuring the NHS Board operates effectively and with openness, transparency and candour; and

• seeking assurance that systems of control are robust and reliable (including financial stewardship).

Specifically, Non-Executive Directors are expected to:

• hold the Executive to account for the delivery of strategy;

• offer purposeful, constructive scrutiny and challenge; and

• chair or participate as a member of key committees that support accountability.

Holding the Executive to account for the delivery of strategy

Holding the Executive to account is a fundamental part of the Board’s role in pursuing high performance. It is important that Boards ensure that the highest standards of governance are complied with, that the organisation complies with all Ministerial guidance and legislation and that a framework of prudent and effective controls is in place to enable risks to be assessed
and managed.

Guidance on how to hold the Executive to account is readily available. The challenge for
Boards and Non-Executive Directors is translating the theory into an approach that works
for the NHS Board.

Being accountable for ensuring the NHS Board operates effectively and with openness, transparency and candour

The NHS Board has an overarching responsibility, through its leadership and oversight to ensure and be assured that the Board and organisation operates with openness, transparency and candour, particularly in relation to patients and public.

The Scottish Government and NHSScotland have a number of policies which support this and Non-Executive Directors should be familiar with the following processes and procedures:

• NHS Board policy on patient feedback/complaints system;

• NHS Board guidance on publishing information including performance data;

• NHS Board policy on whistle-blowing; and

• Statutory duty of candour.

Seeking assurance that systems of control are robust and reliable

NHS Boards are required to have in place structures and systems which manage performance across their organisation, and which provide assurance to Board members of the quality of participation in services. There are a number of ways in which the Board can seek assurance that systems of control are robust and reliable, including:

• quality governance;

• financial stewardship;

• information governance; and

• the committees that support the Board.

There are fundamental differences between being assured and being reassured. Typically,
Non-Executive Directors should aim to be assured more often that being reassured. Non-Executive Directors should scrutinise all information and seek clarification from the Executive.

Assurance	Reassurance
being assured because the Board has reviewed reliable sources of information and is satisfied with the course of action	being told by the Executive or staff that performance or actions are satisfactory

There is a separate resource booklet on ‘governance’ for Non-Executive Directors, which explains this in more detail.

Knowledge and skills

In practice this also means:

• analysing and reviewing complex information;

• monitoring information;

• understanding the principles of data measurement and quality improvement;

• understanding good governance principles; and

• providing constructive challenge and questioning the Executive Team.

Tips for new Non-Executive Directors for developing practical skills:

• practice, these skills will develop over time;

• find out about local training opportunities, visit the QI Hub; and

• visit other NHS Boards to find out about other governance processes.

What Non-Executive Directors can do to ensure accountability:

• make sure that you are clear about how the Board monitors performance;

• determine whether leaders of the Board have a focus on quality and continuous improvement;

• satisfy yourself that systems are in place to ensure appropriate action is taken to remedy problems as they arise;

• question how the Board seeks information from patients and staff to understand and make data meaningful;

• ask what strategies are in place to ensure that staff are clear about their responsibilities and accountabilities;

• consider whether the Board actively seeks to test information against other sources – including direct engagement with services;

• seek assurance from the Board of sustained improvements, where remedial action has been required to address performance concern; and

• ask the Board how it takes account of independent scrutiny.

Further information

The NHSScotland knowledge network http://www.knowledge.scot.nhs.uk has a range of resources that can help Non-Executive Directors develop their knowledge and skills:

• Appreciating the Problem – The Role of Appreciative Inquiry in Problem-Solving– Goodpractice.net (requires and NHSScotland Athens username)

• Negotiating and Influencing – Goodpractice.net (requires and NHSScotland Athens username)

• Credibility and Professionalism – Goodpractice.net (requires and NHSScotland Athens username)

The Quality Improvement Hub provides learning resources, case studies, information about tools and programmes. There are also eLearning modules: http://www.qihub.scot.nhs.uk

• Introduction to Measurement for Improvement eLearning

Healthcare Improvement Scotland http://www.healthcareimprovementscotland.org/

website contains further reading materials including:

Board Level Measurement of Quality: Findings of a 90 day process, 2013, Healthcare Improvement Scotland

Quality Improvement: Sustainable in any culture?, 2013, Healthcare Improvement Scotland

The Institute for Healthcare Improvement http://www.ihi.org also has a range of resources that may be useful, including:

Institute for Healthcare Improvement, How-to Guide: Governance Leadership (Get Boards on Boards), 2012

Institute for Healthcare Improvement – Power of Having Boards on Board