More medical experience is needed at the NHS’s top

Today’s findings on the professional background of board members at NHS trusts are striking, but will come as little surprise to our doctors and nurses.

Out of more than 160 NHS hospital trusts, half do not have a single healthcare professional on their non-executive board. While, by statute, the hospital executive must contain one senior doctor and one senior nurse, it is the non-executives that hold the management to account and make a significant contribution to the trust’s overall strategy. Of these non-executive directors, only eight per cent have any experience on the front line of healthcare.

Ask nearly any doctor or nurse and they will have a complaint about the way their hospital is run: about the edicts from faceless management regarding government targets, or financial restraints – made all the more unpalatable by the knowledge that those in power know so little about the day-to-day reality of working with patients. The paucity of health professionals at the highest levels of the NHS only exacerbates a “them and us” mentality, which is detrimental for the morale of staff and the efficiency of a hospital.

It is also a worrying signal of the overall direction in which the NHS appears to be moving. Nearly half of NHS non-executives have backgrounds in commerce or accountancy. Of course, there is a need to balance the books when funding is so tight, and ministers current and former warn that an NHS tax, or a “membership charge”, may be needed to stop a dangerous slide in the level of service.

But when the top echelons are so replete with bankers, businesspeople and accountants, and so poor in doctors and nurses, the fear is that the wrong ethos has been allowed to take root.

Robert Francis said in his report on the Mid Staffordshire scandal that the NHS had developed “a culture focused on doing the system’s business – not that of the patient”. The way to put an end to that culture is to ensure that the people who know patients best – the doctors and the nurses – are better represented in positions of power.