Marie Gabriel: Lawyers as NEDs in the NHS
BCKR was fortunate to be joined recently by Marie Gabriel who chairs the East London NHS Foundation Trust. Below is a paper which Marie prepared for our breakfast session with useful information and links on what you need to think about if applying for an NHS role. Marie has also generously offered to have a chat with any members who are exploring NHS roles, along with looking at your CV and even putting you through a mock interview. She has a list of typical questions asked at interview which, if you are planning to proceed with an application, we can forward on request.
Lawyers as NEDs in the NHS
To be honest lawyers don’t usually jump out in the list of skills that a Board requires but you do have lots of transferable skills that are valued on those boards
- Generally, its about ability to understand complex information, to analyse and find themes and gaps
- It’s also about good decision making skills, understanding of risk,
- It may be about the specifics of your work, regulation management, estates, contracting, criminal justice, fraud, partnerships, human resources
- You may have experience of large complex organisations or even smaller ones where you have helped to run the business side, make sure you get involved in the business side of things.
Research in 2013 by Cornell University in the US suggested that a legal board presence correlated with performance. According to the study — Lawyers and Fools: Lawyer-Directors in Public Corporations — having a lawyer in the boardroom increased the value of non-financial companies by an average of 9.55% in the study period between 2000 and 2009.
But you will need Board experience e.g. as NED at a charity or at local school and also knowledge of the field you are interested in. So, become involved in local health charities and go along to some public NHS meetings so you can test what is wanted and how NEDs operate.
You will need to review your CV emphasising what NHS organisations want and how you will add value. Behaviours and personal values are just as Connected to this develop your personal and professional networks, find someone who is involved as a NED and let them know you want to become one.
Being a NED is a chance to make use of a life-time of experience for the benefit of some of the most vulnerable people in your society. You can and will have a major impact, not only on the effectiveness of the organisation but also on people’s lives.
The NHS Explained – Core Organisations and Their Roles
Non NED Organisations
The Secretary of State for Health
The Secretary of State has overall responsibility for the work of the Department of Health (DH). DH provides strategic leadership for public health, the NHS and social care in England.
The Department of Health (DH)
The DH is responsible for strategic leadership and funding for both health and social care in England. The DH is a ministerial department, supported by 23 agencies and public bodies.
Although these are non NED organisations there are some bodies that report into the Minister/DH such as the Blood and Transport and the Independent Reconfiguration Panel that do require NEDs. As national bodies you would defintely need previous NED experience
Organisations which have Non-Executive Directors
NHS England and NHS Improvement NHSE&I
These two organisations have come together with a joint staff team but separate Boards. NHS England is an independent body, at arm’s length to the government. The main role is to set the priorities and direction of the NHS and to improve health and care outcomes for people in England. NHS Improvement – that regulates the providers of services, such as local hospitals, mental health trusts and community health , ensuring that they are well run, viable organisations. However both organisations have separate Boards as they is how they were established
The key strategic document is the NHS Ten Year Plan, a must read as it provides the background information you need to become a NED. https://www.longtermplan.nhs.uk/
NHS E&I do have NEDs but you would have had to have a high profile national or international career and previous NED experience
Clinical commissioning groups (CCGs)
CCGs are borough based, clinically led statutory NHS bodies responsible for the planning and commissioning of healthcare services for their local area. CCG members include GPs and other clinicians, such as nurses and consultants. They are responsible for about 60% of the NHS budget, commission most secondary care services, and play a part in the commissioning of GP services. The secondary care services commissioned by CCGs are:
- planned hospital care
- rehabilitative care
- urgent and emergency care (including out-of-hours and NHS 111)
- most community health services
- mental health services and learning disability services
CCGs can commission any service provider that meets NHS standards and costs. These can be NHS hospitals, social enterprises, charities or private sector providers. However, they must be assured of the quality of services they commission, taking into account both National Institute for Health and Care Excellence (NICE) guidelines and the Care Quality Commission’s (CQC) data about service providers.
NICE and the CQC also have NEDs
CCGs have NEDs but they call them Lay Members. More recently GPs have been forming federations of practices as providers of services. These also tend to be borough based and some do or will require lay members.
Responsibility for regulating particular aspects of care is now shared across a number of different bodies, such as:
- the CQC – that inspects the quality of services
- individual professional regulatory bodies, such as the General Medical Council, Nursing and Midwifery Council, General Dental Council, General Pharmaceutical Council and the Health and Care Professions Council
All of these regulatory bodies have NEDs or in the case of Councils they are often call Independent Members. A track record of governance experience is required.
In delivering services you have primary and secondary care. Primary care is usually the first point of contact for most people and includes GPs, dentists, pharmacists and optometrists.
Secondary care services are hospital and community health services and includes planned hospital care at acute hospitals, e.g. operations, accident and emergency, mental health series, community services, such as district nursing, health visitors and rehabilitative care. There are also ambulances Trust that cover a region.
Providers are divided into Foundation Trusts and non-Foundation Trusts. Foundation Trusts have more freedom because they have shown that they are of a high quality and financially viable. They are supposed to be self-standing and self-governing but increasingly are seeing more involvement from regulators. They have a Council of Governors drawn from their local community through election or appointment and hold the Board to account through the NEDs. As such they are responsible for appointing NEDs.
All the secondary care services have Boards and require NEDs. Previous NED experience and a successful career is needed. Foundation Trusts run their own recruitment processes, usually through headhunters whilst non Foundation Trusts recruit through NHS Improvement.
Key Current Issues for the NHS
- Ageing population, increased demand for services, specific conditions on the increase e.g. Diabetes which often linked to life style factors and increased public expectations about access and quality, For example, the Nuffield Foundation estimate that we will need another 17,000 hospital beds by 2022 and that’s just beds.
- Workforce, not enough for current needs, with a 10% increase in nursing vacancies last year plus the requirements of the NHS Long Term Plan. In February 2018, there was a reported 100,000 vacancies. (The workforce comprises of approximately 1.5 million staff.) Compounded by Brexit and new ways of working required by integrated care models will mean retraining. For example there has been a 96% drop in the number of EU nurses registering to work in the UK. Specific problems with nursing, GPs and some consultant speciality. E.g. child and adolescent psychiatrists.
- Money – huge deficits overall. The NHS net predicted deficit for the 2018/19 financial year is £519m with a budget of approximately £2.14bn
- Requirement to work in different ways through Sustainability and Transformation Partnerships. These are good as they are seeking to address regional needs, reducing health inequalities, improving integrated care and access and improve outcomes. However some areas are really struggling to work together or to achieve the transformation needed given population needs and financial problems
- Austerity, particularly the reduction of local authority budgets which has impacted on social care and therefore on things like discharging people.
- Need to better implement digital health
- Need to ensure effective relationships for regional Sustainable and Transformation Partnerships, that have no legal status but are responsible for improving health outcomes and health services along with the viability of health organisations in their areas.
Although you will either be recruited by head hunters or the organisation themselves all NED (or lay member or independent member) roles should be advertised and go for an equal and fair process.
The recruitment process will consist of the following:
- An application form or CV with covering letter
- Sometimes a long listing interview
- A stakeholder event
- A final interview panel
- For NHS Improvement it will be a panel consisting of one of their regional executives and a NED or two from other NHS Trusts.
- For Foundation Trusts this will be members of their Council of Governors
- For other organisations the panel will vary but should always have an independent member.
The recruitment process will also be looking for people with
- Experience and understanding of governance, either as a NED somewhere else or through charity or other public sector work. A useful, although out of date document on the expectations of NEDs and the Boards they sit on is the NHS Healthy Board which can be found at: https://www.leadershipacademy.nhs.uk/wp-content/uploads/2013/06/NHSLeadership-HealthyNHSBoard-2013.pdf
- Commitment to the NHS and the Nolan Principles for Public Life
- An understanding of the needs and aspirations of their local community in general but specifically in relation to health
- Senior executive experience within their career, preferably at Board level
- Specific skills that they need on their Board, e.g. organisation development, HR, finance, estate management, community development etc.
Useful places to look for vacancies:
The first is specifically NHS the second is for all public appointments.
I would suggest contacting their health team and say you are looking for a NED role
- Sunday Times
- The Guardian
Going Through the Process – Hints and Tips
- Keep it succinct, whether it’s an application or CV with covering letter
- Ensure, if it’s a CV with covering letter, that you do draw out key ways in which you address the person specification. Do this both in the covering letter, constructing it as a supporting statement, and within the summary of your successes within your career history.
- If it’s an application form specifically address the areas of the person specification with examples of success. Also send a short covering note, via email or letter highlighting no more than 4 or 5 points
- Use action focussed and strategic words. For example: I have a proven track record of organisational transformation. At Defo I led the merger of 7 organisations resulting in savings of £5m, increased customer satisfaction from 72 to 98% and increased staff satisfaction post-merger from 54 to 92%.
- Show that you are committed to their Trust and their organisation, you are not just looking for a NED role anywhere
- Research so you can add some relevant material, for example I understand that you are in merger discussions with Luton, my experience of mergers and organisational development will……
- Read it through and read it through again
- Illustrate a commitment to quality of services for patients and to listening to patients and staff where appropriate within your answers
- Clinical leadership and understanding of the local scene and national policy is always important
- Research the organisation and the areas within which it provides services so that your answers are relevant, read their strategic documents, recent Board papers and form a view that you can add to an answer. Good places for looking at key policy issues are the websites of NHS Providers and NHS Confederation.
- Be strategic rather than operational, you with the Board set the direction and then supporting and assuring yourself that others are delivering the strategy and performance
- Be yourself and be engaging so proactive your interview responses in front of the mirror or better still organise a mock interview
- Only ask questions at the end if you really have questions to ask