Changes in board leadership and governance in acute hospitals in England since 2013

A new report finds that hospital leadership has generally changed for the better since the Francis Inquiry. There are, however, worrying signs that current high levels of demand, and the financial, workforce and regulatory pressures in the NHS, are putting recent gains in providing safer and kinder care to patients at risk.

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A major academic report has found that NHS hospitals are led in a different way now than they were before the findings of the Francis Inquiry were published five years ago.

The research study, Responses to Francis: changes in board leadership and governance in acute hospitals in England since 2013 published by Alliance Manchester Business School, the University of Birmingham, and the Nuffield Trust was conducted to see how well NHS hospitals are being led in the aftermath of the Public Inquiry into the failings of care at Stafford Hospital.

The research found that hospital board leaders are now more visible to all parties, particularly frontline staff and patients. The report also reveals that patient safety has a higher priority and many boards have revised policies for handling complaints and serious incidents.

Francis Inquiry: big impact

Through contacting hundreds of NHS board members, as well as hospital staff and patients, researchers found that the Francis Inquiry had made a big impact, and that boards are now better informed, and have put in place better policies on key issues including whistleblowing and being open and honest with patients.

However, the report warns that boards face serious challenges in carrying out their role, with 73 per cent of board members surveyed feeling that the biggest barrier to improvement is due to financial pressures and meeting the demands of regulators. There was also a big variation in how thoroughly senior leaders have implemented all their new policies,  how well middle managers are equipped to follow day to day processes through in a consistent manner, and how closely patients and staff are engaged in working on ideas for improving services.

Five key roles for hospital board members

The report concludes with the identification of five key roles for hospital board members, and recommendations about how vigilant hospital boards can help to guard against another Stafford Hospital type failure of care.

Naomi Chambers, Professor of Health Management, Alliance Manchester Business School, who led the study, said: “The Francis Inquiry legitimised the importance of kindness to patients and safe levels of staffing. It was a ‘stop’ moment. Its publication highlighted an urgent need for culture change, which a majority of NHS trusts have responded to.

“From our research over the past two years, it is clear that NHS hospitals across the country have taken measures to organise better care for patients. This is in part due to the more focused and visible approach on the part of boards, but an increasingly challenging policy context is making further improvements more difficult to implement.  Notwithstanding the current strains in the NHS, hospital leaders can continue to play their part, by being aware of the broad repertoire of roles they need to fulfil in order to deliver their mission.”

Judith Smith, Professor of Health Policy and Management and Director of Health Services Management Centre at the University of Birmingham, said: “Hospitals want to provide patients with the best care possible, but external and internal challenges have at times prevented this. Whilst boards are overall taking steps to engage more closely with patients and staff, and ensure they are in tune with the realities on the ground, this report has shown that there is still more to be done to ensure patient care and safety can remain at the top of board agendas in what are very difficult financial and operational times for the NHS.”

The mixed methods study included:

  • literature review, interviews with national policy makers( 2015-16 n=13)
  • national survey of members  of all NHS acute and specialist hospital boards in 2016 (n=381) covering 90% of all trusts
  • six in-depth case studies of hospitals (2016-17): interviews (n=12 per site), surveys of ward and department managers, focus groups with staff and patient groups, board observations (n=2 per site)

The report is an output from independent research commissioned and funded by the Department of Health Policy Research Programme (PR-R11-0914-12003 Learning from leadership changes made by boards of hospital NHS trusts and foundation trusts following the Francis Inquiry Report June 2015-June 2017). The views expressed in this report are those of the authors and not necessarily those of the Department of Health.