Sustaining good board governance: building on the lessons from the pandemic

Paul Devlin profile picture

20 April 2022

Paul Devlin
Chair
Nottinghamshire Healthcare NHS Foundation Trust


Paul Devlin will be speaking at our Governance Conference on 10 May as part of our panel on 'Sustaining good board governance: building on the lessons from the pandemic'. Visit our website to book your place.

It's been a strange couple of years to be part of a board or a council of governors in the NHS. The pandemic has had several presentations, bringing different governance challenges. These have included:

  • The unknown. In the early phase of the pandemic, we were rapidly adapting our governance in the context of a poorly understood, but clearly dangerous virus. This included governance of our organisations, our decisions, our staffing, our services, our procurement, our ethics, and much else.
  • Peaks and troughs. Governance through different waves necessitated actions such as moving to emergency governance arrangements that freed up significant senior time, whether by reducing the evidence supporting governance to "proportionately good enough", or by deliberately delaying some governance activity.
  • Command and control. The period of operating at Level 4, where NHS England and NHS Improvement had national and regional control of much of what our trusts were doing impacted on our governance, whether by necessitating responding to directives or building appropriate, proportionate governance to manage the consequences of centralised "top down" decisions.
  • Regrouping in the lulls. We've had some periods following each wave where we've needed to balance getting things live again or re-focused with the immense toll this has taken on all our staff.
  • Cumulative pressure. Any snapshot assessment of our state of governance will be skewed without understanding the wider context of the last two years.


And we are facing high expectations for recovery, with a national sense that the immediate threats of the pandemic have abated, despite the ongoing pressures on our services and staff, coupled with high levels of frustration in the general public at increased waiting times and bottlenecks in access, along with the substantial cumulative exhaustion the pandemic has brought.

And, from a governance point of view, we should also be thinking about, and acting upon, any actions that reduced or lightened the load during the pandemic, and how we get those back on track. Our audit logs of decisions to pause, postpone or reduce any activity should be informing our post-pandemic plans.

And we need to make sure we don't lose some of the new ways of working that may have been driven by necessity, but in practice have resulted in better ways to serve our communities.

So how do we build on the lessons from the pandemic to ensure good governance?

First and foremost, we need to understand the scale and complexity of the task at hand. This reminded me of David Spathaky, also known as The Great Davido… David Spathaky holds the current record for simultaneous plate spinning. And the governance task we face feels somewhat like his job. Some of what I've learned watching The Great Davido's record-setting activity include:

  • There are multiple actions we need to start, refresh, bolster, rescue and actively observe to succeed.
  • We need to make sure we are not disproportionately drawn to the exciting new things (the newest plates) at a detriment to ones that were "fine when we last looked" (those early plates).
  • We need to retain our intentional focus on the tasks at hand.
  • The support of others around us, well-focused on their role and contribution, is critical.
  • We need to ensure all our plates are getting sufficient attention – some are in better shape than others and some more wobbly, but let's make sure we know which are which. This is different to spreading our resource equally, so needs care and vigilant review.


Where I differ from The Great Davido is in the desire to add more plates, which is, of course, his goal. Rather, I think we should be actively reviewing whether some of our plates can be stood down, taking account of the full current situation, to enable us to concentrate on our priorities. Some might be stopped; some might be passed to others to spin; some may have been subsumed or replaced by a later plate.

So, if good governance has ever felt like an exercise in plate spinning to you, rather than feeling just the pressure of that, let's take the analogy, learn from it, and put it to good use.

(n.b. David Spathaky's plate spinning record stands at 108 simultaneously spinning plates, a record that has stood for 36 years, if you're tempted to give it a go!)

 

Visit our Governance Conference website to learn more about our programme and to book your place. 

About the author

Paul Devlin profile picture

Paul Devlin
Chair

In his third year as chair at Nottinghamshire Healthcare NHS Foundation Trust, Paul Devlin was previously chair of Lincolnshire Partnership NHS Foundation Trust for six years. A self-confessed "governance geek", he's worked with many organisations, including NHS bodies, on aspects of good governance – within organisations, in boards, and in Councils of Governors. Paul has published a series of occasional blogs on good governance, including reflections early on in the pandemic about what good leadership by chairs in challenging times might look like.

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