The NHSCB was formally established as an independent body on 1 October this year and takes up its full responsibilities on 1 April 2013. Its most notable role is the authorisation of clinical commissioning groups (CCGs), the drivers of the new, clinically-led commissioning system introduced by the Health and Social Care Act. The NHSCB plays a key role in the government’s vision to modernise the health service with the key aim of securing the best possible health outcomes for patients by prioritising them in every decision it makes.
What does your role as a non-executive director involve?
My official job description and that of other non-executive directors is to support the chairman by contributing to the wider governance and leadership of the board. I’d hope my background in social care means that I live up to the demands of the role. It’s still early days in the establishment of the board so we’re still in the process of setting things up, and that means actively recruiting thousands of people a month. At the moment any meetings have been orientation meetings and those with executives of the board. Obviously, a key concern is that the board is populated with the right people for the job so it has the correct values and cultures.
What’s important to me as well as everyone else is that we uphold the principle, enshrined in the NHS Constitution, that the NHS ‘belongs to the people’; that it continues to be there to provide high-quality healthcare that’s free and for everyone. The role of the board is ‘to serve the public’ and that is a principle which I passionately believe in.
I have nothing but admiration for the executive of the NHSCB though, especially as it has to function with such limited resources. To me, it’s public service administration at its most challenging. What’s happening with NHS reforms - the scrapping of PCTs and SHAs - is really the equivalent of a major corporate change but without the corporate resources.
What are the challenges facing CCGs?
Getting your head around the speed of change is one of the biggest challenges for CCGs. The sheer grind of administrative detail might seem overwhelming such as the process of electing governing boards and then identifying their objectives and vision. Another challenge is culture. It would be a mistake for CCGs to merely replicate the same approach taken by PCTs and SHAs. They must be champions of change. It isn’t about just swapping one form of bureaucracy with another. It’s about changing the way the NHS is received by both the staff and patients, and about the move from people as patients to them as partners. CCGs need to make sure there is a focus on understanding people with complex needs and to ensure there is parity of esteem between physical and mental health. Understanding their local communities, not just those on the GPs’ books is another major challenge.
A major debate going on at the moment is how do we create an NHS culture? The NHSCB is trying to promote an understanding of community need as well as defining exactly what we stand for. How do you create an NHS brand which is independent of politics and which speaks for the people who are the real face of the NHS? Ministers come and go but the need for a free and efficient healthcare service remains the same.
And of course CCGs must ensure they deliver value for money which is always a challenge.
What are the issues around diversity and staff appointments?
Diversity isn’t simply about black employees. It’s about BME groups more generally as well as women and people with disabilities; basically diversity at all levels. Because of the administrative change in replacing PCTs and SHAs, there inevitably will be redundancies and statistically this affects BME groups and women more. The reality in any organisation is that redundancies tend to be at mid and lower level which is where you find most BME groups and women.
There is a tendency for all organisations to see diversity issues as an ‘add-on’, something you do after the urgent work. But diversity should always be a core part of any organisation’s culture. By this, I don’t mean diversity is just about recruiting BME groups and women. It’s about recruiting good people but making sure there are no barriers for BME groups and women to finding positions within the NHS.
Unless we understand these groups then we can’t provide services for them. It isn’t just intellectual, it’s empathetic. This is a core part of what the board is about and this is of strategic importance for the NHS. If we don’t get it right, we’re not doing our job. There’s a legal duty and a moral, economic imperative to promote diversity.
* Lord Adebowale is non-executive director of the NHS Commissioning Board and chief executive of health and social care provider Turning Point.