Healthy NHS Board: a review of - NHS Leadership Academy

Population health
Population health remains an important priority (The
King’s Fund, 2012). As described in our original review,
it is important that boards have an awareness of local
needs through effective intelligence. For example,
the English Department of Health’s response to the
Francis report notes the importance of local Health
and Wellbeing Boards in improving population health
(Department of Health, 2013c). Also, as outlined
elsewhere, ongoing dialogue with and engagement
of the public (see ‘Ensuring accountability’ (Section
3.2) and ‘Engagement’ (Section 4.3)) may encourage
greater ownership of organisational priorities and
services, and the public health message. This effect is
potentially stronger in NHS Foundation Trusts, where
the governance structure might give the public a greater
sense of ownership, though research indicates some
progress remains to be made in this setting (Ocloo et al.,
2013, Wright et al., 2011, Allen et al., 2012b).
Resource management and productivity
Analyses conducted both before and after our original
review note the existence of a significant ‘productivity
gap’ in the NHS and the need to reduce variation and
waste (Appleby et al., 2009, Appleby et al., 2010,
Department of Health, 2011).
Chambers et al’s recent review suggests that, despite
exceptions mentioned elsewhere, there is limited
empirical evidence on the relationship between board
composition and organisational performance (Chambers
et al., 2013).
Productivity is influenced by a number of workforce
issues (West et al., 2010, McKee et al., 2010, Boorman,
2009, Appleby et al., 2011, Committee on Standards in
Public Life, 2013). Staff turnover is identified in a review
on engaging boards as a major cost to organisations
(West et al., 2010). Research suggests HR practices,
including staffing, training, and sophistication of
performance appraisal, are associated with productivity
(McKee et al., 2010). Boards may support improved
productivity through supporting robust management,
performance benchmarking, and engagement; such
activities may align staff with organisational priorities
and reduce absenteeism (it is noted that 70% of
spending in acute and mental health trusts comprises
cost of staff) (Appleby et al., 2010). However, research
on productivity recommends that boards be aware of
the need to balance a drive for productivity with the risk
of staff burnout (Maben et al., 2012).
22 The Healthy NHS Board, 2013: Principles for Good Governance