NHS Trusts

NHS Company Secretary Services

Boards of directors of NHS Trusts are required to meet a code of governance that sets out best practice principles and processes to contribute to better organisational performance and provide safe, effective services for patients.

In fact, the duties of an NHS Trust director bear many similarities to those of a company director as defined in the Companies Act 2006.

Corporate governance failures

In-depth research by icsa: The Governance Institute suggests many NHS boards are failing in key areas of corporate governance.

Its ‘Mapping the Gap’ report highlighted a significant gap between best practice in theory and actual performance, notably:

• 10% of agenda items were regarding strategy, markedly failing the best practice recommendations of 60 percent;
• Just 5% of NHS boards aligned clinical and quality issues to strategic objectives;
• Board members were more frequently issued with items to note than asked for concrete decisions;
• Just 75% of board agendas included items which were declarations of interest;
• Clinical and quality issues took up between 4% and 13% of the top five agenda items, failing to reach the governance guidelines of a minimum of 20%;
• 1% of those surveyed in the questionnaires agreed that a priority for the board was involving the public in shaping NHS healthcare services.

Challenges for executive NHS directors

The main challenge for an executive director within the NHS is to manage to keep the right balance between the various roles for which they are being paid:

• leadership and management of their particular section or department
• being a member of the senior operational management of the organisation
• wider leadership and management responsibility within the operational environment
• ensuring the organisation remains focused on delivering its core business objectives
• governance and strategic responsibility from the board perspective.

The multi-faceted nature of the chief executive’s role means there is an inherent conflict between their duties as a manager – to use the assets of the organisation to fulfil the operational objectives of the organisation and deliver the strategy determined by the board to provide high quality and safe care – and their governance role of ensuring sufficient assets are aligned against the operational objectives, while also guarding, maintaining and nurturing those same assets.

Bridgehouse Company Secretaries understands the particular challenges faced by NHS executives.

If you’d like to discuss the governance support we can provide for NHS trusts, please get in touch.