New joint board will need flexible response

There are plenty of hard workers on the 14 regional NHS boards around Scotland.

Some are executive directors and responsible for the finance, medical, nursing, public health, human resources and pharmacy areas. The chief executive has the task of leading that team, while making a sound and progressive relationship with his or her part-time chairperson. Boards generally follow annual and five-year plans, which are published on their website. Of course, urgent political and health concerns come along and require deliberation, funding and effort. Often the Scottish Government will allocate additional money for such need but exactly how that is spent is often a board responsibility. We hope where evidence exists that informs action.

The role of non-executive directors on health boards and company boards is fascinating. In the NHS they are appointed via a national recruitment process, have to live or work in the board area and usually bring skills and experience from work elsewhere, life or sometimes as consumers of health services.

The chair and nonexecutives are there to hold the management team to account on behalf of the population and the cabinet secretary for health, wellbeing and sport. How much they exercise this responsibility in private and public is hugely influenced by the person occupying the chair.

Once a year the health secretary or colleague brings senior civil servants to meet in public with the board chair and senior management team. Members of the public can submit questions ahead of that meeting.

NHS Forth Valley reviewed non-executive activity some nine months ago, a year after new chief executive Jane Grant arrived from NHS Greater Glasgow and Clyde and more than two years since Alex Linkston became chair. Very few members of the public attend public board meetings, which are held every two months on Tuesday mornings. Even journalists miss some meetings. One reason for that may be that the agenda is not published till the week of the meeting and the papers are embargoed until the start of the meeting. Often these agendas will run to 200 or 300 pages, somewhat difficult to assimilate as the meeting unfolds.

Boards gather every month and on alternate months a board seminar is held, usually bringing in clinical managers who outline strategies and problems and propose solutions. The board members can then question them and discuss the topics of the day. These meetings are not held in public, which is understandable but frustrating for those with an interest in particular areas.

Is the non-executive role worth the cost to us taxpayers? Remuneration for a notional day a week is £8000 per year. That’s the equivalent of an annual gross salary of £40,000 – somewhat less than MSPs, headmasters, doctors but better than average annual income of £28,000.

The aim is to to bring in the expertise of individuals whose time would cost much more if they were paid at the going rate for their other work but then to get the best from them.

In business the absence of women from boards and corporate governance concerns has been ventilated at intervals. The UK Government Higgs review in 2003 continues to be referred to, a report which emphasised the need for non-executives to hold to account and the importance of corporate governance.

The experience of the Co-op, RBS and others in more recent times suggests that board members need particular expertise. The biggest change in health boards’ function is taking place over the next 12 months. Newly created, integrated joint boards will take responsibility for running all of adult social work and primary and community care. They will also control the budget for much else including emergency care, in-patient older people and medical wards and mental health services. This emphasises the importance of the social care response to the needs of older people in particular, hand in glove with meeting their more medical needs at home and in hospital. Solving delayed discharge problems is part of this.

A flexible response across social work and health board areas of activity will be required in future. Councillors from Clacks and Stirling and non-executive directors from NHS Forth Valley Board form the bulk of the new Stirling/Clacks board. This transitional integrated board plan to hold their monthly meetings in public from July onwards.

With the Westminster election out of the way but a Scottish election next year, just how this big, new fund is prioritised will be tough and telling. After all, it comes from two culturally different organisations: cashstrapped local authorities and a large part from health boards’ budgets, which have been relatively sheltered.