Governing the English NHS : exploring the role and contribution of the Primary Care Trust Chair and Non-Executive Director

Tweed, Joy (2017) Governing the English NHS : exploring the role and contribution of the Primary Care Trust Chair and Non-Executive Director. Doctoral thesis, Birkbeck, University of London.

Abstract

The area of research interest for this study was the governance role of non-executive directors (NEDs) and Chairs on NHS Primary Care Trust (PCT) boards across England. This interest arose from the experience of the author, herself a PCT NED, who was aware of some of the tensions of the role that resulted from a model of corporate governance and accountability imported from the private sector to the public sector. The NED role was more complex within PCTs as there were additional stakeholder expectations of providing public accountability. The changing policy landscape also saw NEDs responding to different Government priorities and developing the role in quite different ways to their counterparts in the private sector. Newman’s (2001) model of governance is a dynamic one that highlights the tensions caused by the Government’s use of different types of governance mechanisms, seeking to achieve sometimes-conflicting goals. In this thesis the model is developed to consider how these tensions led to a differentiation of roles in practice for NEDs. The empirical analysis is based on interviews with 52 PCT NEDs and Chairs across England between October 2011 and April 2012. The dominant emphasis for some respondents was the efficiency of the organisation, reflecting principles of new public management and providing accountability to the taxpaying public. Other respondents saw their accountability as being to the local community and patients, and their role to defend these interests. They saw themselves as having a role both within and outside of the organisation, oriented towards a decentralised model of governance and working collaboratively with other stakeholders to improve health outcomes. This study identified that the NED role as a defender of public interests provided a motivation to act, was a source of power and was one influence on the board as it tried to act within the tensions of operating as a local organisation, responsive to local need in addition to meeting nationally-determined targets. Previous studies found the NHS NED role to be marginalised, but this study found PCT NEDs and Chairs able to exercise power to achieve results in line with their interests, although their power was often constrained by the power of other actors, notably the Strategic Health Authorities acting on behalf of the Department of Health. Even though PCTs have been abolished, the corporate governance model of a board and NEDs remains in hospital trusts and other parts of the public sector to the present day. The tensions between national and local accountability remain. This thesis provides support for a differentiation of NED roles, recognising the limitations of the new public management approach and a model of corporate governance from the private sector. While those NEDs with business expertise may be able to contribute to organisational efficiency, there is also a need for NEDs with a public service interest and the skills to influence and work collaboratively with stakeholders to ensure health services best meet the needs of communities.

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