Non-Executive Directors and Mortality Assurance in the NHS ? Are they Fit for Purpose?

Abstract

In UK NHS organizations, Non-Executives on Boards of Directors play a critical role in ensuring that organizations are delivering safe patient care. The role of Non-Executive Directors (NEDs) is to ‘challenge the decisions of the Board and help develop proposals on priorities, risk mitigation, values, standards and strategy’. This paper examines the extent to which they are able to do this in areas where the assessment of risk and its mitigation requires highly technical medical knowledge. Specifically, whether the highly technical nature of trust mortality data represents an obstacle to the proper and effective functioning of the Non-Executive Directors and their ability to question and hold operational directors to account for poor performance. This work is pertinent in light of recent high profile failures in corporate governance, where abnormal mortality statistics (and other important indicators of poor patient safety) have not triggered an appropriate Board response or corresponding remedial action. Using a mixed methods approach generating both qualitative (interview) and quantitative (survey) data this paper provides an assessment of NEDs’ knowledge and capabilities in the area of mortality assurance. The findings show that with the exception of those that are clinically trained, NEDs feel that they are unable to properly scrutinize trust mortality rates and hold the Board to account for the suitability and appropriateness of responses. They perceived themselves to be heavily reliant on the integrity of the Medical Director and to be unable to provide independent assurance in this area. These findings suggest the need for additional specialized training for Non-Executive Directors in order for them to properly and fully undertake their roles. ‘Non-Executive Directors should satisfy themselves as to the integrity of financial, clinical and other information, and that financial and clinical quality controls and systems of risk management and governance are robust and implemented.’