Rookies’ guide to getting to grips with governance

A post offering tips on becoming an effective NHS Foundation Trust governor

When, last year, I was elected as a public governor of my local NHS Foundation Trust, frankly I knew little about governance for a large organisation, and virtually nothing about the workings of the NHS. My Trust, covering 8 hospitals with 36 governors, is one of the country’s largest integrated care providers, extending throughout the whole county, employing 7,000 staff and providing for a population of more than 650,000. Mine was a scorching initiation.

To its credit, my NHS Trust provided a comprehensive overview of its workings and the role of the governor in a full day of training, covering guidance from NHS England (formerly Monitor) – the ‘overseer’ of NHS Trusts, telling how exactly governors fit into the hierarchy of the Trust, what they can and cannot do, and how they are expected to fulfil their role.

Of course, such training provides little more than the nuts and bolts of the mechanics of governance. But good governance owes more to judgment calls than it does to rules and regulations. It is clearly an art, for which some are equipped – and others struggle.

This post is aimed at those with whom I have resonance, who may be interested in serving as a governor but who may struggle to overcome the mammoth task of getting to grips with the art of governance.

What exactly do governors do?

Put simply, NHS Foundation Trusts have three layers of governance. First, the Executive Directors, headed by a CEO, are employed by the Trust to administer the organisation. They ensure that the right staff are recruited, that statutory services are delivered in a timely way and the NHS Trust stays within its budget. Next we have the non-executive directors of which my Trust currently has five. Their job is to oversee the salaried executive. These too are paid positions and require specific skill-sets to ensure that each of the core duties of the Trust is managed appropriately by the executive and that planned outcomes are achieved. Together with the Chair, the Executive and Non-Executive Directors make up the Board.

The Council of Governors, elected by members of the Trust – the public and the staff, together with those nominated by a handful of stakeholders, is the last line of governance, effectively holding to account the non-executive directors for the performance of the Board. The Chair has the challenge of ensuring that the Board
works effectively, as a team, and in conjunction with the Council of Governors.

It follows that governors are not elected to direct the Trust, but to check on it from a public and staff point of view. Is it being managed appropriately, efficiently and sensitively? Is it remaining within budget and solvent? How is it faring against its targets? Is it delivering health care that patients and the public would expect of it?

How do we, the governors, do it?

The key mechanisms for governance are the regular meetings of the Council of Governors at which the directors explain and justify their actions and decisions. Meetings are attended by the executive directors, non-executive directors and of course, the governors. They provide an opportunity for governors to gain insight into the Trust’s day-to-day workings and performance, to question the Trust’s progress and performance, and to provide appropriate input from a public perspective.

Additionally in my NHS Trust, governors are expected to join one or more sub-committees that have delegated authority to oversee, input and to make recommendations to the Council. In the Durham and Darlington NHS Foundation Trust these comprise ‘Audit and Governance’ (the committee on which I serve), ‘Nomination and Remuneration’, ‘Quality and Healthcare’ and ‘Strategy and Planning’. Their titles indicate the extent of governance expected from public and staff governors.

Overall, public governors should expect to attend approximately twelve meetings throughout the year, in person or by video platform, and to undertake additional evening training sessions that cover a variety of responsibilities.

My take on governance

Whilst not unique by any means, I accept that my working lifetime as a barrister provides me with a raft of questioning skills – a core asset for a governor. More often, changes in outcome result not from challenging an opinion or from stating a view – but from asking the right question of the right person. When answering questions we undertake a journey of self-examination that can bring about a change of outcome. The right question may be a pathway to discovery.

Over the last year as NHS Trust governor, by asking the right questions, I have been instrumental in bringing about the following changes:

1. Introduction of an executive report cover sheet, setting out the purpose of each report we are asked to read, the key issues covered in it, and identified risks that could arise from it.
2. Introducing ‘agenda-setting’ to take account of governors’ questions and issues.
3. Changing the format of meetings from ‘lecture-based’ – to ‘inquiry method’.
4. Providing recognised channels for communication between governors and non-executive directors.
5. Challenging pre-existing assurance level terminology to make it more understandable.
6. Enabling document viewing on iOS using VPR Academic CAD tool.
7. Introducing peer support systems to ease the path for new governors.

Why stand for election as a NHS Foundation Trust governor?

These days, everyone appears to have a view concerning the NHS. And most of us, in our lifetimes, will be recipients of care from it. Health care, whether personal or as a national issue, cannot simply be left to providers.

Whilst NHS Boards will wish to focus on patient safety and quality, their priorities – when juggling with patient throughput, budget decisions, cost savings, institutional perception of service requirements – may not always be in line with ours. It is only by getting involved that we can make any difference.

Imagine – you, a friend, or relative – are admitted for treatment in terminal life-care. What would be your expectations of your hospital and the treatment you receive? Would you expect your medical notes to be read and understood before undergoing treatment? Would you wish to have family visits with a semblance of privacy and dignity? What communication would you expect from your clinicians?

Should your answer to any one of these questions be that you care, then I sense you may already have answered my question as to whether you should become a NHS Trust governor.

Advertisements appearing within or at the foot of this post are placed by the platform, not the writer. They are neither endorsed nor monetarised.

*

*

*

*