The move toward place-based planning across the health sector places accountability and governance at the centre of debate. Lay members, according to Susanne Hasselmann, will be crucial in making sure local areas get it right.
Over the last two years we have talked much about the value lay members bring to clinical commissioning group
(CCG) governing bodies and how CCGs can maximise this value. With my first term on the NHS Clinical Commissioners (NHSCC) board coming to an end, I was musing about how far we have come as CCGs and in our roles as lay members/non-executive directors on governing bodies.
I was also thinking about my own situation, the training I have received and the development opportunities I have had, and how CCGs across the country can best ensure the next generation of lay members are recruited and equipped to support effective governance and engagement through a changing commissioning landscape.
With the recent NHS delivery plan further supporting developments such as accountable care systems, and increasing moves towards place-based planning with sustainability and transformation partnerships (STPs), making sure we get accountability and governance right will be crucial. Lay members play an integral role in this. Making sure there are credible systems in place that will give the public and patients confidence their voice is heard and that taxpayers receive the value they expect from the money they spend is critical to the success of this transformation.
Maximising the value lay members can bring starts with effective recruitment and carries through to induction, training and succession planning. CCGs need to sow the right seeds to reap the full benefits – here are my reflections on how they can do so in the years ahead.
What to look for
A chief executive once said to me that he felt an effective board should challenge him and make him feel uncomfortable. According to him, that is the sign of a board with good non-executive representation and a process that supports good decision-making.
CCG lay members act as traditional non-executives and are there to provide constructive challenge, scrutiny, and an external view. In fact, Sir Malcolm Grant stated at our NHSCC network conference
in November that CCG lay members are non-executive directors.
With this in mind, it is clear that lay member recruitment must be robust and thorough in terms of its selection to ensure we get the best people for the job who have the qualities, experience, and knowledge to act in an effective non-executive role.
Resilience and an ability to build credibility is needed of those individuals. Any recruitment process therefore needs to take these personal characteristics into account.
A diversity of perspectives is critical for an effective governing body, and it is therefore important to balance experience in the NHS and public services with non-NHS experience that brings a fresh view to the table.
Inducting and training
Once the lay member has been recruited, many CCGs have informal induction processes in place that include meeting the chair and the executive leads, as well as some of the clinicians on the governing body. There may also be a more structured induction package available, including training around information governance, safeguarding, CCG working practices and structures, as well as governance arrangements.
Good induction processes – which are not universal across the country – are very important to have, and will be the subject of one of the checklists NHSCC will launch later this year.
In spite of the challenges that remain, I do believe that we have made really good progress in terms of offering greater opportunities for technical training for lay members. This includes NHSCC’s collaboration with NHS England around training on delegated primary care commissioning and the training available for lay members concerning conflicts of interest.
NHS Improvement and NHS England have also hosted a number of opportunities for CCG lay members and trust non-executives together on a number of topics, including place-based governance and engaging with clinicians.
Succession planning and retaining expertise
This now leaves me with my final thought: what do we do with those lay members who have considerable experience in the NHS and have built wide networks of contacts over the years?
With the current commissioning structure, CCG lay members rarely have the opportunity to progress to a chair's position as these are mostly held by GPs in CCGs. So, how do we ensure we don't lose talent and experience to the lay member graveyard?
As part of STPs, we have started to talk much more about integration at a local level, and how CCG lay members and NEDs may transition to other parts of the sector. It may be that NHS England can play a role to ensure that those people who are deemed to be effective are offered appropriate NED development opportunities in the wider NHS or public sector. Either way it is a discussion we need to have, so that we make sure we retain the best talent to help the NHS in challenging times.
There is still a huge amount of work to be done in this area. Over the next year, NHSCC’s Lay Member Network will be working proactively with colleagues to provide practical support and share best practice so that as the health and care system changes we make sure we recruit and support the best possible non-executive talent to help deliver a sustainable NHS fit for the future. We look forward to sharing with you what comes next.
Susanne Hasselmann is a lay member at NHS South Eastern Hampshire Clinical Commissioning Group and chair of NHS Clinical Commissioners’ Lay Member Network. Follow her and NHSCC on Twitter @SusanneHas @NHSCCPress.
NHSCC members can see a more detailed briefing on this on the members-only area of the NHSCC website.
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