Notes from the field of public involvement

Saturday, 05 February 2005

A la Guillotine
A Tale of two Cities - Bradford, Wolverhampton … and rumbling towards you soon?

Bradford and Wolverhampton provide an intriguing contrast about who has powers to remove NHS Boards, when those powers can be used and what Board Chairs are responsible for.

Bradford Beheading

Monitor used Section 23 of the 2003 Health and Social Care Act to remove Bradford’s Chair, John Ryan, an experienced local politician, after concluding that “the Trust is not currently complying with the requirement in its Terms of Authorisation to operate effectively, efficiently and economically, and that the failure to comply is significant.” Documents released by Monitor under the Freedom of Information Act tell the bigger story about how this flagship Foundation Trust failed the “3Es” test. Keeping bad news from Monitor clearly has significant consequences – at least for FT Chairs.

On the removal of Chairs

Bradford’s escalating financial problems were not the Chair’s sole responsibility, despite Monitor’s view that “the Chairman’s role was to ensure effective financial stewardship through value for money, financial control and financial planning and strategy.” One could argue, therefore, that Monitor should have used Section 23, as it could, to remove the rest of the Board at the same time as the Chair. . But axe-ing a whole board risks destroying public confidence (but maybe not, see the case of Wolverhampton below). And who would run the organisation if the senior executive directors as well as the NEDs were removed?. So perhaps Monitor should just have removed the Chair and the NEDs? But that could look even more like scapegoating the lay board members for the failure of their executive colleagues. Could Monitor have put in locum NEDs as well as a locum Chair, or could the Board have done without NEDS until (the question is who?) was able to recruit and appoint more. It’s a moot point which may come to a head if interim chair Peter Garland is not able to turn the Bradford ship around in six months.

Shopping for new ones

So who will find new Directors for Bradford if they are required in mid 2005? Sir William Wells of the NHS Appointments Commission confirms this week in the HSJ that it has no remit to appoint chairs and NEDs in FTs. That’s a role for Boards of Governors, but surely the recruitment process for FT NEDs will be handled by the Commission? One must remember of course that the Appointments Commission did appoint all those NEDs who were rolled over when their Trusts became FTs. Indeed, the Bradford Chair was reappointed as recently as February 2004. What a difference a couple of months can make. All of which raises the question “does the Appointments Commission know what it should be looking for when it comes to filling FT Boards?”

Wolverhampton: Apres Tinston, lesTumbrils – plenty of room for NEDs inside

Meanwhile down the road in Wolverhampton, the Appointments Commission exceeded Monitor’s wrath by removing the Trust Chair, Professor of Nursing Mel Chevanne, and the NEDS from the local acute two-star acute Trust following a damning governance and financial management review by the Strategic HA. The Tinston Report (links to Adobe PDF) concluded the Wolverhampton Trust NEDs had not challenged the Board executives about allowing a ballooning £10m deficit. But in Wolverhampton, the Chair alone didn’t carry the can for financial failure. This seems inconsistent at best when contrasted with Monitor’s view of the Chair’s role. Perhaps someone should be addressing that before prospective FT chairs get even chillier feet.

“Heads Roll”

The local Wolverhampton Express and Star noted the Trust Board’s departure thus: “The heads have rolled and maybe the new brooms will sweep things clean. But it can't come as a shock to find that a group of well-meaning amateurs put in charge of a highly-specialised, multi-million-pound business will come unstuck.“

Instant Regime Change

Presumably Sir William then found a new Chair and new NEDs for Wolverhampton because they are in now in place according to the January Trust Board agenda. Seems pretty quick work, so are there “Boards in waiting” somewhere just waiting to be parachuted in when things go pear shaped in a Trust? We might know the answer if the Appointments Commission had a website and put documents in the public domain. As it is, finding out how it went about the Wolverhampton swap is a mystery. Perhaps a strong draught of FOI would work here too.

Andrew Craig | (Problem occured connecting to database: The server requested authentication method unknown to the client