Tom Goodfellow

Why are trust boards so unbalanced?

“Time like an ever rolling stream bears all its sons away” (Issac Watts)

I find it hard to believe that nearly six months has passed since I cleared my desk, deleted all incriminating emails, listened to some very nice (but largely untrue) speeches and walked away from the life I had known for over forty-seven years (including time at med school).

“You will miss it” they all said, and of course they were right – but it was still the right thing to do. I knew that the time had come and that I needed to get out and get on with the rest of life however long or short I have left. I have had no second thoughts.

“We will miss you” they said, and they probably did for a week or two, but then soon the organisation takes over and the gaps are plugged. I think it takes about three months for you to become only a faint memory to many, and as new staff come and go it is as if you never existed.

But it was not until I had retired completely that I realised just how completely knackered I was.

The NHS is now not an easy place to work. The demands are complex, relentless and frequently unachievable. I pity the poor guys who will have to work until they are sixty-eight or even older before they get their pensions. The severe shortage of doctors in some specialities, including my own, is imposing huge strains on individuals and I think that burnout will become an increasingly common problem. Even more so as they implement full seven day working.

“So what are you planning to do?” is usually the next question, “Are you going on a world trip?” Well no, although I am soon off to Vilnius (Eurovision fans will know where that is) for a short break; that is if Putin doesn’t get there first.

I exercise regularly and I am learning to play the piano. The first keeps my body fit and the other, surprisingly, keeps my mind very active but is proving much harder than I initially thought it would. However I enjoy the discipline of practising although frequently my left hand very definitely does not know what my right is doing!

So what of the future? I continue as a clinical associate to the governance unit of a large law firm and, although the investigations are still fairly few, the work is very absorbing and I am learning a lot.

But as of this month I have made a decision to apply to become a non-executive director (NED) of a trust board if I can find one that wants me. This “poacher turned gamekeeper” idea might seem a bit strange but my main reason is this.

During my last six months before retirement I became the interim Clinical Director for radiology. The trust executive run a programme of quarterly reviews for all departments (new since my original time as CD) and each is assessed against a comprehensive dashboard of various standards covering most aspects of the service. The execs will come down very hard on any team who do not meet the targets or miss the mark.

However as I sat, with my team, across the table from the serried ranks of execs I realised that, other than the CMO and the Chief Nurse, all the rest were men and women in grey suits! That is they were overwhelmingly non-clinical (I am being factual not judgmental – they are all excellent people). So we were faced with the situation of the clinical being called to account by the non-clinical, and frankly I became very uneasy about this.

There is a business agenda and it is perfectly acceptable for this to be challenged by management, but the clinical should take precedence and, in my view, the balance was not there.

But I think the situation is worse at board level. The role of the NEDs is to challenge the executives and call them to account. But if you look at the composition of most boards the NEDs, although generally well qualified people in their own field, are overwhelmingly non-clinical. So in a service dedicated to the delivery of healthcare you have a balance of non-clinical NEDs calling non-clinical execs to account. This inevitably means that the agenda will tend be dominated by financial and corporate rather than clinical governance.

The NEDs, no matter how well intentioned, cannot fully understand either the intricacies of clinical practice or the rapid developments in all fields of medicine. Is it only me that thinks this is wrong and unbalanced?

This approach, I believe, started with Margaret Thatcher who seemed to think that the way to get the NHS to work better was to get high powered industrialists to review and even run the service. TV programmes were made by such industrial worthies as John Harvey-Jones and Gerry Robinson as they attempted to apply a business model to the service.

Although clearly some insights were useful the overall impression given by those programmes is that they both simply didn’t have a clue when it came to the NHS.

I personally believe that anyone who has had been a successful clinical manager of a large hospital department is as competent as any industrialist, and probably has more insight. However I accept that this view may prove too contentious and the mind-set of boards may be fairly fixed.

I note that a few adverts for NED posts ask for clinical experience although most seem to be looking for accountants.

In my governance work which involves reviewing hospitals which have had “issues” I have learned that the NEDs in each case were completely unaware of what was happening at the clinical coal face until the proverbial hit the fan by which time it was too late – the genie was out of the bottle and the media onto the case.

So I will apply for any appropriate NED roles which come up and see what happens. What I will offer is an ability to turn over the stones and see what is underneath – but with a strong clinical perspective.

Whether or not I will be successful I have no idea. But at my age I think I can cope with rejection and failure.

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