Guardians of public interest: the expectation and experience of non-executive directors in National Health Service commissioning boards in England

Abstract

PurposeThe purpose of the study is to examine how Non-Executive Directors (NEDs) in the English National Health Service (NHS) commissioning bodies experienced their role and contribution to governance.Design/methodology/approachSemi-structured interviews were conducted with a purposive sample of 31 NEDs of Primary Care Trusts (PCTs) and 8 Clinical Commissioning Group (CCG) NEDs. Framework analysis was applied using a conceptualisation of governance developed by Newman, which has four models of governance: the hierarchy, self-governance, open systems and rational goal model.FindingsNEDs saw themselves as guardians of the public interest. NEDs’ power is a product of the explicit levers set out in the constitution of the board, but also how they choose to use their knowledge and expertise to influence decisions for, as they see it, the public good. They contribute to governance by holding to account executive and professional colleagues, acting largely within the rational goal model. CCG NEDs felt less powerful than in those in PCTs, operating largely in conformance and representational roles, even though government policy appears to be moving towards a more networked, open systems model.Originality/valueThis is the first in-depth study of NEDs in English NHS local commissioning bodies. It is of value in helping to inform how the NED role could be enhanced to make a wider contribution to healthcare leadership as new systems are established in the UK and beyond.

Board dynamics and relational tensions in the English NHS foundation trusts

“…The relatively less literature on the latter focuses on: the role of NEDS and governors in board governance (Wright et al. , 2012; Tweed and Wallace, 2021) and associated behaviors for effective boards to ensure quality and patient care (Chambers et al. , 2017, 2020), the way NHS board meetings are conducted (Peck, 1995; Peck et al.…”

“…Similarly, we know more about the "what" of board governancestructure and basic principles in the NHS instead of the "how" of board governancethat is, board dynamics, processes and overall functions (Veronesi and Keasey, 2010;Collum et al, 2014;Aly et al, 2022). The relatively less literature on the latter focuses on: the role of NEDS and governors in board governance (Wright et al, 2012;Tweed and Wallace, 2021) and associated behaviors for effective boards to ensure quality and patient care (Chambers et al, 2017(Chambers et al, , 2020, the way NHS board meetings are conducted (Peck, 1995;Peck et al, 2004;Veronesi and Keasey, 2010), various strategies used by NEDs to create accountability in boards (Sheaff et al, 2015); perspectives of directors and governors regarding accountability in boards (Dixon et al, 2010) and so forth. Some of this research employs observational methods, which further reveals the emergence of board dynamics as a significant element, but largely overlooks the interactional dynamics and the way it influences board processes and practice.…”