Sir Thomas Hughes-Hallett is Chairman of Chelsea & Westminster Hospital NHS Foundation Trust. He is the Founder and Chairman of The Marshall Institute for Philanthropy and Social Entrepreneurship at the London School of Economics and the former Chief Executive of Marie Curie Cancer Care.
What changes would you make to NHS boardrooms to make them more effective?
There are two issues I’d want to address. Firstly, the attitude to risk taking. And secondly, the focus on the short term.
On the first point, the NHS is going through such a difficult time that it’s going to need a non-incremental approach to tackle it. Crises tend to make boards more risk averse and, having been an investment banker through the crashes of ‘87 and ‘89, I saw this first-hand on City boards. But NHS boards are going to have to step up and take greater risks in the boardroom if they’re to overcome the challenges they’re facing.
On the second point, I think there’s a tendency among NHS boards to deal with the here and now, rather than sit back and consider the long term. For instance, it’s important to know how many patients we’re dealing with at any one time (a good indication of the constraint on our resources is the queue for the bathroom – I’ve struggled to find a free loo for the past two weeks!). But the urgent day-to-day matters can distract boards from planning for the future, which is what they need to do.
What is the single biggest leadership challenge facing NHS boards?
It’s a three-part challenge. Firstly, the instruction to be solvent. Secondly, the need to provide continuous, high-quality care with limited resources. And thirdly, the ever-increasing demand from the British public.
An economist might say addressing all three challenges is impossible, but I’m an optimist so I cannot take that view. For me, the key will be for boards to stop complaining and think outside the box. One solution may be to involve hospitals more closely with their communities, volunteers and charities.
How important is the role of the Trust Secretary?
The role of the Trust Secretary is as important to the board as the role of Chairman. If the relationship between the two is one of absolute trust, the Trust Secretary can act as an advisor to the Chair, sharing their experience and knowledge. Any Trust that hasn’t yet recognised the value of a good Trust Secretary could have a good thing coming once they do.
How important do you consider information in the boardroom?
Receiving huge tomes of information is a real challenge for NHS boards. Staying on top of everything we receive requires an incredibly well thought through committee structure and a ruthless approach to board materials.
We keep our papers short, indicating clearly where action is required from the board. I discourage papers that are for ‘information only’ – the board simply doesn't have the capacity to digest everything. That’s why dashboards are so effective, they tell us at a glance our key metrics.
What book is on your bedside table?
I recently read Philanthropy and the Hospitals of London by Frank Prochaska, which explores voluntarism in the healthcare sector over the 19th and 20th centuries.
When William Beveridge wrote his report in 1942 he made it clear that the state needed to provide minimum levels of health and social care, but not remove the opportunity for voluntarism. Since then, we seem to have moved from a society which balances duties with rights, to a society which demands rights without acknowledging the duties that come with them. That needs to be rebalanced, particularly in the health sector.
What is your golden rule?
Have fun every day! I promise three things to anyone who works with me: you will always have fun, you will never be bored and I will always be loyal to you if you do a good job. I think this is why I’ve led stable boards and management teams throughout my career.
