LEADERSHIPAND MANAGEMENT
of conflicts of loyalty in commissioning decisions.”
The debate and amendments since then have not reassured ICSA, Thomson said.
“One of the guidance notes is a model conflicts of interest policy for CCGs, and it’s still a work in progress, because the governance arrangements around CCGs are still unclear. ICSA and other professional bodies with an interest in making sure there is accountability and transparency, and that we avoid conflicts of interest in those situations for the public benefit, still have to keep monitoring the situation and revising our guidance so that it is the best it can be. But I think there is still some way to go on working out the governance arrangements for CCGs, because they’re not good enough yet.”
Counter-argument
just from the point of view of a particular patient group or membership body.”
The report also contains specific guidance on behaviour issues, with advice for board members on what is and is not appropriate and useful before and during meetings – from non-verbal gestures to mobile devices.
Theory and reality
In their answers to questionnaires, many board members clearly felt their meetings dealt well with strategic issues, or clinical/ quality issues, while Thomson’s analysis of the agendas themselves suggested this was rarely the case.
“When you actually analyse the agendas of the trusts, there isn’t really that much that looks at clinical and quality issues, certainly not the 20% recommended by best practice. You could argue that if they’re talking about a specific performance- related management line, that they’re taking the finance, performance, clinical/ quality issues all in one go – but I think you have to be there at the discussion to discover whether they really are discussing the ‘quality’ angle.”
Asked if the boards generally contained the right people, or if some needed a wider shake-up, Thomson said: “There are those who perform well, and those who don’t perform quite so well, both non-executive and executive directors. That’s a charge that can be levelled at other organisations and types of boards as well.”
The debate about open vs closed meetings
is now effectively “obsolete”, Thomson said, because of the provisions in the Health & Social Care Bill – which was close to becoming law as NHE went to press.
“All trusts are going to have to have open board meetings. The impetus now should be making them relevant, real and meaningful, and that’s a challenge. Done well, they can be good things; done badly, they just come across as being stage managed and rehearsed.
“There’s a nervousness, understandably; board members don’t want something to come out that might be a slight problem that’s then whipped up into something that is more than it is.
“But for those people who go and attend these meetings, both press and the public, they really appreciate some honesty, along the lines of, ‘this was a problem, this is what we did to rectify it, these are the les- sons learnt’. I think people can forgive mis- takes, as long as lessons are learned and they’re not made again.”
CCGs’ ‘inherent conflict of interest’
When it was published last summer, the Mapping the Gap report was blunt about the governance shortfalls in the proposals for clinical commissioning groups (CCGs): “The make-up of clinical commissioning groups introduces an inherent conflict of interest which is not satisfactorily resolved by the introduction of two lay members, a registered nurse and specialist secondary care doctor. Other robust mechanisms are required in order to neutralise public perceptions
In the
spotlight: many trust members need training in how to fulfil their role more effectively
Feedback on the report, Thomson suggested, has included some board members insisting that they do discuss strategic issues more than her report would suggest – just not in open meetings.
Thomson took that on board, but told NHE that having analysed so many board papers, she remained unconvinced that there was enough decision-making on strategic issues taking place.
The original report made eight main recommendations, including around better training, and the new guidance and specimen codes should also help.
Thomson said the provisions of the NHS reforms will also have an inevitable effect, especially the vastly enhanced role that governors will play at foundation trusts.
She concludes: “They’re going to have a potentially very powerful role, and will need new skills and training to be able to hold the board to account effectively. They’ll wield the power of veto over some really big questions that will face trusts in the future.
“To govern effectively they’ll need ongoing extra support, training and information. In turn, trust secretaries will have to work hard to ensure that relationship between the council of governors and boards of directors is fruitful.”
FOR MORE INFORMATION The Mapping the Gap report is at
tinyurl.com/Mapping-the-gap The new and updated guidance can be found via
www.icsa.org.uk/nhs
national health executive Mar/Apr 12 | 29
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