Effective challenge on a unitary board

Abstract

This is the third of four articles that explore a range of problem areas in foundation trusts that have caused the trust to have been identified by the FT regulator Monitor (now NHS Improvement) for special attention. These problem areas focus on the board's insight to its business, the information it has for decision making, the effectiveness of the non-executive challenge function, and how executives are held to account. This learning is equally applicable to governing bodies of clinical commissioning groups. This third article in the series considers the effective challenge function within the board. Resulting from governance reforms in the early 1990s, the challenge function carried out by non-executives—with the aim of more effective decision-making and greater assurance—has not stopped the failures of governance in the NHS. Three areas are explored to get under the surface of the challenge function: first, the level of balcony thinking that underpins an effective challenge function, allowing non-executives and the board overall to understand and shape their context rather than be buffeted by it; and second, the type of behaviour that is effective when carrying out the challenge function on a unitary board. Last, the article explores how the challenge function plays out in different settings such as committees and in public board meetings. In each area the article highlights the problems and makes recommendations to improve how the challenge function can more effectively work in practice. The article concludes with a set of actions that the board can implement to improve the challenge function it experiences. The final article in this series will focus on board effectiveness in holding executives to account for the implementation of board decisions.