Day 20: What’s a Board to do? #107days

Day 20 was adopted by Amanda Reynolds. Amanda has a lot of experience of NHS Boards, she offered her support to #JusticeforLB early on and kindly agreed to share a post for #107days on what an NHS Board Member is there to do:

I have been thinking about Boards and their key remit a lot recently. Last year I was on an NHS Foundation Trust Board and it was a water shed year for governance and leadership. It was the year when both the Francis Report and the DH response were published. We stopped, shuddered, shook and should have changed a lot. But, did we in the end do that?

I was also very aware, like many, of the failures of Winterbourne View and wondered how any Health and Social Care Board could get itself into such a distant and unknowing place in regard to what’s happening in its own services. And now via twitter another Trust is in trouble with the avoidable death of Connor Sparrowhawk. His family and learning disability experts are making a loud noise and are rightly outraged.

So, a few reflections on what is a Board for? I have a feeling CQC, Monitor and DH are asking such questions about Southern Health right now. What is common in each case is the first to make a big noise are not the Board or the staff but the families. Is there a pattern emerging here about who are the best people to spot, and be listened to when we need to assure ourselves of the quality of the care we provide?

But, do we have to wait for a Julie Bailey or a Dr Sara Ryan in every Trust, shouldn’t each Board be proactively in charge of quality? Absolutely, as without an effectively governing Board no service can assure us it is safe and of the highest quality. But worse none of us as users of the NHS can be confident in the care it provides us and our families.

Essentially the Boards job is to govern or as Plato would have said “to steer”, BUT the Board is a collective being, a collection of Individuals who come together to govern. So each individual with a vote is first and foremost part of a unified board and an accountable individual also. These two things are not mutually exclusive. They do need to be understood as each Board member has two key responsibilities  overall responsibility for quality and a personal responsibility to act effectively and to assure themselves the organisation is well run.

If you can’t sleep at night or you are a Board member there’s lots to read that can help you understand an NHS Board and its governance responsibility better here: published in November 2012, Standards for members of NHS Boards and Clinical Commissioning Groups Governing Bodies in England and from Monitor in April 2013, Quality Governance: How does a Board know that its organisation is working effectively to improve patient care, and August 2013, Your statutory duties: A reference guide for NHS Foundation trust governors.

So, back to a Board working day to day maybe you have heard something like  “the Board decided that but I did not know the full picture when we decided it”. This is never an acceptable position for a Board member (Executive or Non-Executive) to express. Each member must ensure they know all they need to know to govern their organisation effectively. This is not a small task but a core requirement if an NHS Board is to be well led. Really important when things go wrong in delivery of quality of care as in the case of Connors avoidable death.

Prior to the recent Southern Health Board meeting it was discussed on twitter whether the Chair and members knew all the information in relation to Connors’ death. So, in the context of excellent governance and the Boards key remit this is something the chair will need to be seek to address urgently. The chair must assure themselves that non executives have the full information on this avoidable death and any action the trust has taken since. Monitor excellently outlines their understanding of a Boards remit by challenging each NHS Board to really govern by knowing not just hearing and nodding through decisions.

Quoting from Monitors report on quality governance for Boards published in April 2013: “The Board should understand the organisation and what they are being told is true, accurate, fair and backed up by sufficient evidence.”

I have to say when I read the public board papers of Southern Health March 2014 meeting I was a little disappointed that their self-assessment was not more rigorous and there did not appear enough soul searching or challenge reported within the Board for me.  An avoidable death of a young man had occurred here.

There has been a lot of focus in the media on criticising the CEO and they do hold day to day responsibility for the running of the Trust. But, it is important to realise they work to an NHS Board like all others a unified board. So, individually and collectively each member with a vote is accountable here, not just the CEO and chair.

So, if I had a chance to question Southern Board I have pondered some of the questions I might start with:

Qu 1: does each Board member understand their individual and corporate responsibility here for this failure of care?

Qu 2: where are the NEDS in the current dialogue and responses by the Trust are they sighted and signed up to all actions?

Qu 3: can each of the Board members satisfy monitor and CQC that they know what went on, what went wrong and that services are now safe today? What evidence do they have to support this view?

Qu 4: does the Trust Board understand its responsibilities to patients and families enshrined in law as part of the NHS Constitution? Has it acted on them in relation to Connors death and engaging his family?

Qu 5: After Connors avoidable death how can the public be confident that the Trust are providing safe and effective health care to all inpatients with Learning Disability now?.

It is a huge challenge to govern a health care organisation effectively and I do not place my reflections or this challenge out there lightly. Each Board needs to work from a position of development and constant review. Challenging yourself, your Board colleagues and your organisation constantly. Gaining and interrogating knowledge so the Board collectively can be refreshed and reflect on the quality of what it does each and every day.

Specifically, a message for The Board of Southern Health. You should be listening to and engaging the family of Connor here.  First and foremost to address their concerns properly but to use this feedback to assure the Board collectively that your services are safe and each patient is getting good care. So, the Board can be confident in confirming to its community, commissioners and regulators that it is governing a quality organisation.

As Toni Collett said “ The better you know yourself, the better your relationship with the rest of the world”.