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DRIVING THE NHS FORWARD

NHS Chief Executive Sir Nigel Crisp identified understanding the impact of greater choice and contestability as central to the future success of Boards in delivering high-quality patient care in a patient centred NHS.His vision also includes boards giving clear directions for shaping and delivering local services and connecting with the communities they serve.Sir Nigel, addressing an NHS Confederation event last month entitled The Importance of Boards, said: 'The world is changing fast - the job of an NHS board will be very different in future. So we should not just be asking 'do boards make a difference?' but 'will boards make a difference in future'?' Foundation trusts were highlighted as one development within the modern NHS that illustrated the changing role of boards and the need for rigorous controls.He said: 'The creation of NHS foundation trusts, more than anything else, underlines the critical impact that boards will have. The need for robust governance systems, accountability and very high standards of professionalism in business and financial management is clear.'Sir Nigel made clear to delegates that Boards in the NHS were already making huge differences to the health of local people. He said 'We have Boards delivering unprecedented improvements in the quality of care for patients. 'They do this by having a clear direction, keeping a relentless grip on performance, setting stretching goals for their organisation and paying real attention to all their stakeholders. They expect - and get - disciplined management at all levels in their organisation. Staff are confident because they know the place is well run. Patients walking into the hospital can see an institution that cares for their needs.  Local people know what is happening with their health service. People want to come and work for them.However, Sir Nigel said that at such a crucial point in the journey to transform health care in this country, there had to be recognition that there was variability in performance and real scope for improvement.'Most Boards do a good job in keeping their organisations on an even keel and managing the very complex bundle of strategic and operational issues that make up today's NHS. But some find it less easy to add value and keep a grip on delivery, the quality of patient care and financial control. We all know examples where this has led to service failures and meant that patients have suffered'Sir Nigel said that Boards could rely on continuing commitment and support from the Centre in the future. Through the Appointments Commission, there will continue to be a commitment to rigorous appointments procedures, high-quality training, and a systematic appraisal system to compliment the existing talents of board members.  But Sir Nigel also pledged to give boards the space to lead and set direction, as long as they demonstrated clear accountability to local people for the role they play, explaining, 'this is our clear intention - the performance of all boards will be vital to the future success of the NHS.'Over 170 senior NHS leaders attended the event, including more than 30 non-executive directors and 70 chairs. In an NHS increasingly devolved of Whitehall control, Sir Nigel identified strong financial governance, fair recruitment policies and effective communications as some of the key issues to be tackled, saying:'We must be crystal clear about governance responsibilities, particularly around areas of financial management. There is no room for complacency in a system where we still have a few Boards discovering black holes within the financial year.' In the era of patient choice, Sir Nigel said it was critical that all trusts recognised, responded to the corporate challenges, and worked with key stakeholders across the board. 'For all NHS Trusts, success in a world of greater choice and contestability will depend on having a very clear business strategy based on a sound understanding of how they will operate in a more diverse provider system. They cannot be passive and let the strategy emerge from what individual departments do. They will need to be much faster at innovation and adapting to changing conditions, and be alert to joint ventures.'Sir Nigel said that Trusts would also need to routinely measure performance across the board and strive to earn a reputation for clinical excellence, patient safety, quality of the caring environment provided, staff behaviour and sensitive treatment of individuals.'A key test for boards in future will be their ability to manage relationships with partners in a mature and constructive way. There will obviously be differences of views and real tensions to resolve as we learn to use the new incentives in the system but we should have effective mechanisms to work these through - an explicit set of values we share and work to, underpinned by agreed behaviours and responsibilities.'This would be aided by the national leadership network recently set up by Sir Nigel, comprising leaders - representing both staff and patients - from across the health and social care sector. He will also encourage local leadership coalitions. Sir Nigel underlined the continuing objective behind the direction of the NHS; 'everything we are doing is designed to place the patient at the centre of this service'. He stressed the need for trusts to take the lead in developing effective and, crucially, people-centred communications and marketing strategies.'Fundamentally, I see boards using professional marketing techniques to understand the needs of those they serve. This is not marketing as selling. This is marketing in terms of gathering and using rich intelligence about how people live their lives and how to tailor their health offering to fit in with individual needs.'Sir Nigel pointed to the recent public health White Paper as a prime example of how boards could exert greater influence on the future direction of the NHS.'Choosing Health provides PCTs with a strong platform to position health as a unifying challenge across local partnerships. Alliances forged through local strategic partnerships and now local area agreements in some parts of the country will be major drivers for change.'On recruitment, boards had a key role to play in both 'talent spotting' and succession planning.  He said: 'This is something we need to do much better at all levels of the NHS and something high on my agenda. Central to this is our ability to draw talent from all parts of the community. You will know the importance I am placing on the equality agenda and I am pleased that in terms of Board appointments we are making good progress.'In summary, he said: 'Boards make a difference now but there is more we can do to raise performance. We all have a role to equip tomorrow's boards to do the new job that the public needs them to do. We must build a set of incentives which allow boards to experiment and try new things to benefit patients and improve the health of local communities.'Below Non-Executive Bulletin recaps the developments and reforms to be rolled out shortly that will form part of the essential financial toolkit for boards.