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He may have been appointed on April Fools' Day, 2002, but it was no joke for Richard Beazley. The large acute hospital trust was struggling to deal with an unpopular merger, as well as having difficulties meeting waiting time standards. Working closely with Nick Carver, the new chief executive, governance structures were strengthened, a new management team was built, a new and inclusive management structure was implemented, and trust was rebuilt with the community. In addition to all this there was the need to manage the fallout from the unheralded closure of a children's ward, a waiting list manipulation review and various other difficult legacies.The experience acquired during a career spanning more than 20 years as a lawyer, economist and chief executive working for a very large multinational business engaged in large, capital intensive and risky operations helped him to deal with these issues."Much of the work I had been involved in within the private sector was relevant to the trust. In particular, forming teams of people from diverse backgrounds who were encouraged to face up to, analyse and deal with issues within a clearly defined governance and management structure was welcomed by the trust.  Diversity is not just a politically correct process, it adds significant value to any organisation; and particularly to those which, like the trust, have very talented and committed staff," said Richard.In Evolving Corporate Governance in NHS Trusts, Richard discusses ways in which governance practices in the NHS might draw on recent private sector experience to help it evolve to meet new challenges."A lot of work has been done in recent years to strengthen governance in NHS trusts, which is now probably in better shape than in many private sector companies. However, the introduction of foundation trusts, patient choice, payment by results and the involvement of the independent sector in treating NHS patients will require NHS governance structures to evolve further."This will not be easy, but looking at recent private sector experience should help identify some of the more important (and difficult) governance issues that trusts will need to work their way through."These are likely to include:
* the role of boards and directors, against the backdrop both of public debate following recent corporate governance incidents on both sides of the Atlantic, such as the downfall of Enron, and the many reporting relationships in the NHS that operate outside corporate governance structures
* the increase in directors' responsibilities (and liabilities)
* the very welcome move towards an environment where resources and activities are directly aligned
* within the context of the involvement of the private sector in providing both capital and services to the NHS, the need to ensure conflicts of interest are prevented Richard said: "While the trust still has a lot to do, it now has a sparkling, if challenging, future. "This includes a new independent sector surgicentre and PFI hospital, both of which are part of the recently approved Bedfordshire and Hertfordshire Strategic Health Authority's programme, and a postgraduate medical school. "It also includes foundation status, patient choice and payment by results. These developments will require the trust's board to spend a good deal of time evolving the governance structures that will be needed to manage this programme."These points are key themes discussed in Richard's paper, which he has written as a starting point to help his board get to grips with these issues. Richard added: "It's very challenging, but very interesting and well worthwhile." Tell us about your experiences as a chair or non-executive. Email RM.Bulletin@apcomm.nhs.uk

• Click here to read the paper. (opens new window)