Just 8% of NHS trust non-exec board members are healthcare professionals, study finds

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Half of NHS hospitals do not have a single doctor or nurse on their non-executive board, a new study has revealed, in findings that have revived fears over the “commercialisation” of the culture of the NHS.

Overall only eight per cent of non-executive directors at more than 160 NHS trusts had frontline health care experience, compared to nearly half with backgrounds in commerce, finance or accountancy.

NHS trusts operate a board and non-executive board system modelled on the corporate sector. While by statute each NHS trust must have one senior doctor and one senior nurse on the executive board, non-executive boards, which hold the hospital management to account and help set overall strategy, have no such restrictions set upon them.

The study, carried out by researchers from Bournemouth University, also found that nearly two thirds of chairmen at NHS Foundation Trusts have a background in commerce, finance or accountancy, compared to just four per cent who are healthcare professionals.

Out of 1,001 non-executive directors, only 82 had a frontline healthcare background and only two were “patient representatives”, the study’s authors said.

Professor Colin Pritchard, of Bournemouth University’s School of Health and Social Care, told The Independent that the findings were evidence of what he called “a silent takeover our hospital trusts by commerce and by finance thinking.”

The NHS Trust Development Authority, the arms-length body of the Department of Health with responsibility for appointing NHS non-executive directors, said it was “very important that [boards] have a wide range of skills to assist and scrutinise the business of running a hospital.”

The lack of health professionals at the top of the NHS management structure has been a long-standing source of frustration among care professionals. Several studies have shown that hospitals with more frontline health staff engaged in management roles perform better and recently the leading think tank the King’s Fund has called for more doctors and nurses to take on management roles within hospitals.

In his landmark report on the Mid Staffordshire scandal, Robert Francis identified the disengagement of doctors from the way the hospital was run as one of the factors that led to care failings. He also criticised the development of a culture in the NHS “focused on doing the system’s business – not that of the patient”.

Professor Pritchard said that the culture which Francis described had been created by non-clinical leadership in the NHS.

“The frontline staff have never had lower morale… The voice of the patient, and the frontline staff, is not being heard by the people who now run the health service, which is invariably lay managers and their boards. They’ve got the model entirely from corporate business,” he said. 

“The frontline professional representatives – the people who know the business – are in the minority. These non-executive boards are not competent to hold the executive to account, to say: ‘what is the effect of a policy on the frontline staff and their morale and on patient outcomes?’

“I fear that what has happened is the silent takeover of our hospital trusts by commerce and by finance thinking.”

Dr Clive Peedell, a consultant at the James Cook Hospital in Middlesbrough, and co-leader of the National Health Action Party said that the figures highlighted “the increasing commercialisation of the NHS”.

“[It shows] NHS trusts stuffed full of financiers and business people, focusing on business plans rather than care plans, and placing a higher level of importance on balancing the books rather than standards of patient care,” he said. “Without the involvement of people who have frontline medical experience and clinical leadership skills, how will we ever improve the standards of patient care in the NHS?”

Responding to the study, published today in JRSM Open, part of the Journal of the Royal Society of Medicine, a spokesperson for the NHS Trust Development Authority said: “We acknowledge how important it is that boards have representatives with medical and nursing backgrounds, however it is also very important that they have a wide range of skills to assist and scrutinise the business of running a hospital.

“It is part of our role to ensure that NHS trusts have the best possible mix of skills and experience around the board table.

“We have made it easier to appoint non-executive directors with a clinical and nursing background in particular. Now we can appoint chairs and non-executives to more than one role and to those working in other roles in the NHS, including doctors and nurses, so that we can better harness the skills and experience available within the NHS.”