I recently had the pleasure of chairing a day with Governors from a number of NHS Foundation Trusts, sharing experiences about their roles, and helping facilitate some joint learning. I found myself thinking about some of the factors that help ensure Governors are able to carry out their roles effectively.

One of the key duties of NHS Governors is to hold Trust Non-Executive Directors (NEDs) to account for the performance of the Board of Directors. That makes sense, but can be more difficult to put into practice than it might seem.

A key focus that can help Governors is to look for evidence of the assurance that NEDs themselves have sought. By “assurance”, I mean the evidence that the NEDs have sought to be sure that what they are being told is correct. Seeking assurance isn’t about disbelief, but is rather about seeking confirmatory evidence.

NEDs are responsible for ensuring the good performance of the Board. However, this isn’t always straightforward to achieve. The Board of a Foundation Trust should operate as a unitary body. This means that the Executive Directors and the NEDs all have a similar duty to act on behalf of the Trust, and to ensure they work together as one team. This can be challenging for some Boards, particularly those built on more traditional processes where NEDs hold the Executive to account rather than acting collectively.

So what does this mean for Governors? Here are a few thoughts of mine:

1. Who is presenting Governors with information?

As a Governor, are you getting information from the Executive Team or the NEDs? If the information is being presented by Executive Directors rather than NEDs, then there is potential for confusion in how you carry out your governance role: it is for NEDs to hold the Executive to account, not Governors.

If NEDs present performance assurance data to the Council of Governors, there is a closer scrutiny on their role, and the opportunity to ask questions of the NEDs. But be aware: for example if, when you ask questions of NEDs, responses are fielded by Executive Directors, is this because your question is delving into the operational, or is it because the NEDs aren’t up to speed on their own assurance? A key question to ask the NEDs might be “How are you getting assurance that this action will contribute positively to the issue at hand?”

2. What is being presented to me?

NHS Trusts – like other complex organisations – can be very adept at producing papers! Good papers perform the function they are supposed to, rather than just providing data.

When it comes to assurance on Board performance, Governors should be alert to the kind of information they are being presented with. If you get practically the same performance report that has already gone to the Board of Directors, then there may be a risk of confusion of your role. It is for the NEDs to seek assurance on the performance report, but is for you as a Governor to seek assurance on the assurance NEDs have had. That requires a different level of information.

A simple change that I have seen help a Trust on this has been to ensure the presentation of a Performance Assurance Report to the Council of Governors. Immediately this leads to a different type of paper from a performance report: the focus is on evidencing the assurances that have been sought, gained, or are still being queried, rather than getting submerged in the detail on performance. Of course, as a Governor, you should still be able to access performance data if you desire – it might inform your understanding of the assurance you are being presented with. But watch that you don’t get pulled into operational detail, as this risks you losing focus on your critical role of holding the NEDs to account, and risks you duplicating the NEDs’ role of holding the Board to account for performance.

3. Can I see the assurance that has been sought, gained, or remains unachieved, and does it make sense?

A good NED will be able to respond to a challenge about the assurance they have sought and will be able to describe what they have asked for and show how it gives assurance (or otherwise) that performance is on track. This means Governors should be able to answer a “So what?” question on the assurance sought, and get their own confirmation as to whether or not the NEDs have carried out their assurance role effectively.

For example, if the Trust is not hitting the waiting time targets for a particular service, the performance assurance evidence Governors will be looking for might include:
• Assurance that the NEDs understand any trends in underperformance (i.e. how do they know it is a trend rather than a one-off ‘blip”?)
• Assurance that the NEDs are confident in the quality and accuracy of the data the Board is presented with
• Assurance that the NEDs have tested out why proposed actions will be likely to have a positive impact, and assurance that the NEDs can show how they will know if/when the actions have had an actual impact

4. Have I had my questions on assurance answered?

It is, of course, a statement of fact that Executive Directors and NEDs are likely to be closer to the detail of the activity of a Trust than a Governor is. But that doesn’t excuse Governors not getting the information they need to fulfil their assurance role.
If you feel your questions on assurance have not been fully answered, it is important that this is recognised. Ask yourself questions like:
• “If I am not clear about the assurance the NEDs have sought, what more information do I need?”
• “Do I need to reframe my question to help the NEDs understand what I am after?”
• “Do I need to – respectfully – suggest that my question has not been answered and that I’d like someone to have another go at responding?”

And if you feel your assurance questions are not being answered, despite your best efforts, then ask the Chair for her/his view. They should be “holding the round” and ensuring Governors are able to carry out their roles as effectively as possible. If it is unclear to you whether you’ve been able to hold NEDs to account, then it is likely to be unclear to others in the room too, Governors, NEDs, Executive Directors, and members of the public alike.

The Governor role of holding NEDs to account for the performance of the Board of Directors is one important way in which Governors fulfil their responsibilities to their constituency – whether a geographic constituency, a group of patients or carers, a staff group, or a local partner organisation or stakeholder. It is important Governors are supported in carrying out this important function and it should be welcomed by NEDs, Boards and wider Trusts alike.