April 1991 and Beyond: Are Health and Social Services Boards Catching the Tide of Change?
| Date | 01 June 1993 |
| DOI | 10.1177/095207679300800204 |
| Author | Michael Connolly,Mary Russell |
| Published date | 01 June 1993 |
| Subject Matter | Articles |
April 1991 and Beyond: Are Health and Social
Services Boards Catching the Tide of Change?
Michael Connolly and Mary Russell
University of Ulster at Jordanstown
ABSTRACT
This paper is a preliminary assessment of the changed role of health and social
services boards in Northern Ireland since their restructuring as management
bodies by the government. Key changes in board restructuring are designed to
make executive and non-executive board members more accountable and
responsive to health user needs. This study seeks to discover some of the
characteristics of the first group of board members. This includes their
composition, operation and role.
Non-executives are appointed on the basis of the professional and
administrative expertise that they can contribute to the planning and policy-
making processes performed at executive level. They need to be on par with
executives who have now acquired the dual roles of policy planning and making
decisions in the boardroom. For non-executives, a prior knowledge of the health
service is not required; chairmen interviewed in this study prefer their members
to show an interest in and demonstrate commitment to the health service.
’
Introduction
The health services throughout the United Kingdom have been subject to almost
continuing reform since the early 1980s (Pollitt 1990). For example the Griffiths
Report (October 1983) recommended radical proposals for reforming the NHS
management. More recently we have had the reforms outlined in the 1989 White
Paper &dquo;Working for Patients&dquo;. A persistent theme in all the reforms has been a
critique of health service management. As Griffiths put it:
rarely are precise management objectives set; there is little
measurement of health output; clinical evaluation of particular
practices is by no means common and economic evaluation of those
practices extremely rare. Nor can the NHS display a ready
42
assessment of the effectiveness with which it is meeting the needs
and expectations of the people it serves. Businessmen have a keen
sense of how well they are looking after their customers. Whether
the NHS is meeting the needs of the patient, and the community,
.
.
and can prove it is doing so, is open to question.
’
(Griffiths, 1983, p 10)
In part response to these criticisms there has been the recent reform of health
authorities/boards. Up to 1989, regional and district health authorities (RHAs and
DHAs) in England consisted of a chair and between 16 and 19 members. The
chair of both RHAs and DHAs was appointed by the Secretary of State, as were
the members of the RHA. Members of DHAs were appointed by the RHA.
However the region was required to consult various interests. Thus the RHA had
to appoint a representative of an appropriate university. Further, between four
and six members of DHAs were appointed by relevant local authorities. Similar
principles applied to other parts of the UK (the Northern Ireland system which
provides the empirical base for our research is described in more detail below).
The Government was clearly dissatisfied with the performance of boards. In
particular they were unhappy with the size (arguing that this inhibited decision
making), composition (arguing that authorities lacked managerial expertise) and
role confusion (wondering whether members were managers or representatives).
The past performance of board members, it was alleged, often reflected an uneasy
alliance of considerations about managerial effectiveness and democratic
representation by various interest groups (see Day and Klein 1987). The
argument was that members’ decision-making was limited by the tribalism that
local councillors and union representatives displayed during board meetings.
Pirie and Butler (1988) claimed that the quality of leadership in the NHS was
subject to &dquo;political prejudice&dquo; and special pleading. Other academics argued that
in the past members acted as ’rubber stamp’ (Ham 1989), though there were
alternative views suggesting that some board members, at least, influenced
’
policy
(Ranade 1985, Pettigrew et al 1991 ).
During our research it was alleged that the system encouraged some board
members to act in an &dquo;irresponsible&dquo; manner. For example local councillors
would agree to a proposed plan at a committee meeting. Subsequently they
would alter their views at public/council meetings, voting against board
proposals, they had originally supported. In the words of one non-executive we
interviewed, board meetings often &dquo;generated more heat than light&dquo;.
In sum the government argued that:
the (health) authorities based on this confusion of roles would not
be equipped to handle the complex managerial and contractual
issues that the new system of matching resources to performance
will demand. The members needed to work in the new system
should be appointed on the strength of their skills and experience
they can bring to an authority’s work. If health authorities are to
discharge their new responsibilities in a business-like way, they
need to be smaller and to bring together executive and non-
executive members to provide a single focus for effective decision-
43
making.
(Working For Patients, 1989, para 8.5).
As a result the government, greatly influenced by how they thought boards in
the private sector operated, advanced a number of reforms (Working for Patients
1989). Membership of authorities in England was to be reduced to five non-
executive and up to five executive members, plus a non-executive chairman. The
Secretary of State was to be responsible for appointing the chair and non-
executive of RHAs and the chair of DHAs. RHAs were to appoint the members
of the DHAs. Non-executive members would be appointed on the basis of the
skills and experience they could bring to the authority. Local authorities no
longer were to have the right to appoint members to DHAs. The executive
members were to include the general manager and the finance director. Other
executive members were to be appointed by the non-executive members acting
with the general manager.
The purpose of this paper is to explore some aspects of the initial operation of
health boards under this new system. In particular we will focus on the role of
non-executive members and their perceived contribution to the work of health
authorities. Our empirical base is the NHS in Northern Ireland. There are
important differences between the system there compared with other parts of the
UK
and generalisations are difficult to make as a result..Nevertheless, apart from
learning about the Northern Ireland experience, we believe that some...
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