22 July - Non-executive directors - Getting to well-led and staying there, with Dr Olu Olasode

This week’s session, on the topic of ‘getting to well-led and staying there’, opened in conversation with Dr Olu Olasode, non-executive director East Kent Hospitals University NHS Foundation Trust. Dr Olasode has more than 32 years of executive leadership experience and 25 years as non-executive director and chair of audit and governance with several health, social care, housing, community development and private sector organisations, including the Care Quality Commission, the Audit Commission, and with local and central government.

Dr Olasode said: “For me it’s all about good governance, leadership and strategy and when I think about the CQC’s processes and domains and the key lines of enquiry, it’s all about what we feel as colleagues is reasonable to deliver the object of an organisation to a clear vision, directions and strategy. The experience I’ve had with the CQC framework is that it doesn’t recognise the context within which organisations are – trusts are at different stages of their journey of improvement. There is also the question about whether it’s evolved enough to cover different areas of leadership and governance. There’s more focus around ICSs and partnerships on engagement and the domain needs to develop further in that area.

“There isn’t a set of variables or protocols that you can take to an organisation and say, ‘this is what you need to do to show that you are well-led’. There are key areas and key proxies for that. Everyone in this group, whether executive or non-executive, wants to lead effectively and wants to provide adequately their fiduciary responsibilities that go back to the Companies Act – so they want to see patient care at the forefront, they want to see improved outcomes, they want to see continuous improvement – the framework does help with that, but it doesn’t cover everything.

“In East Kent we’re trying to get back to good, then outstanding. Not only is the trust working on the priority areas within the domain but we’re also looking at other things beyond that. It’s not just about satisfying the CQC, it’s also about leading an effective delivery organisation.

“It’s important to recognise context – it’s part of what the CQC takes on board. But it’s understanding the relativity of where leaders and governance frameworks and structures are in relation to the context of the organisation. More importantly, colleagues on boards should be able to inform that process, so go beyond applying the structures and framework to challenge themselves on what are the proxies and outcomes for running an effective and delivering an improving organisation and you find that the narrative around that will give a richer experience of where you are along that journey than a set of questions and answers will. For example, we’ve got more and more trusts asking questions around partnerships and the governance around that. And some trusts and boards have gone beyond that to develop a better engagement relationship and challenge to provide more effective leadership of the system.

“The CQC domain also challenges the competence of leaders. But it’s about using that expertise, that competence, that experience to improve processes. I keep going back to the concept of reasonableness and fiduciary responsibilities, going back to the Companies Act many years ago – that’s where I started my career and that’s where everything leads back to. You have an appointment to lead an organisation as a non-executive; what is reasonably expected of you? And if we go back to that we’ll find that we bring more out of us as a collection of non-execs than what the framework suggests, I think.”

On supporting boards as they go through the CQC process:

“The system doesn’t provide enough support – for me a lot of it is about learning capacity and peer reviews and benchmarking. Boards that set the bar in terms of an activity – maybe financial turnaround, maybe levels of patient care, incidences of infection control, whatever it is – based on what they see as a good standard out there. A good question we ask our board against every report is ‘what’s the best practice out there? What are other trusts doing and how do we compare?’ That’s where you set your benchmark really so it’s important to ask that question. And coming to meetings like this where you discuss what’s happening elsewhere – there needs to be more and more of that.

Also overheard during the session:

“It’s very rare that an organisation doesn’t have some aspect of what they do which they’re very proud of. Staff feel quite put out when the CQC doesn’t come and see them. I think there’s something about balancing that inspectorial approach of the CQC with recognising publicly that there are some good things going on, even within orgs that require improvement. I think that would have a really positive impact on those of our colleagues working on the front line.”

“I couldn't agree more about leadership being where the buck stops in well-led terms. However, the issue is people have different ideas and definitions of leadership. Some see it in isolation (single tunnel vision) and some in a matrix. Going forward the questions is what it will mean to partner organisations within an ICS and how we can get to a common understanding to be well-led together.”

“Well-led is also about putting aside the competitive nature of work and focus on the greater benefits to the population. How can NEDs work across the system to evidence well-led?”

These meetings are by invitation and are open to all NHS non-executives directors, chairs and associate non-executive directors of NHS providers. Others may attend by special invitation.

If you have any comments, questions or suggestions about these webinars, please contact: events@good-governance.org.uk