Learning from high profile failures: Governance lessons for CCG lay members

thiNKnow_NK_Bulb_LRGGovernance has never been in the public eye so much.  Everyone, from any walk of life, could probably cite at least one major governance failure from the last few months.  VW emissions, Kids Company, FiFa, Russian sports doping.  With the harsh financial circumstances currently faced by the NHS and the ever constant stream of new initiatives it is fair to predict that at some point, one of our 209 Clinical Commissioning Groups may also find itself in the very intense spotlight of governance failure. Good lay members can do so much to help prevent this.

Some CCG lay members have been recruited specifically because they have expertise in finance or governance matters.  BUT all HAVE to become governance experts.  Whilst it is the responsibility of the whole board no-one else in the CCGs will be focussing on good governance in the same way as the lay members.

So I asked myself what lessons might be found in these high profile cases that could help CCGs, and lay members in particular, to further develop their expertise.

I identified three commonalities between them.  There are probably more, but three is a good number and these three are particularly relevant.


  1. the presence of strong charismatic leaders;
  2. a failure to focus on a clear common vision that is delivered in the context of an explicit and shared value base; and
  3. missed opportunities for appropriate questions to be asked and answered.

Let’s take them one at a time. First, strong charismatic leaders are necessary to drive change. They are more necessary in our current context than ever before and its really not the fact that they are strong or charismatic that is a problem.  However, when others are in awe, or become star struck they fail to see circumstances in the round.  If lay members lack the confidence and strength of character to challenge, then important details may be missed and signs of things going awry may go un-noticed.   And so the challenge for lay members, or NEDs, is to be brave enough to work with charismatic leaders and to be resilient enough to challenge them when necessary.  Your presence and gravitas in the context of the board is essential.

And my second point.  Most organisations have described their ambition in a vision statement of some kind.  That’s great but it’s just not enough.  Let’s look at some of those recent, high profile failures and imagine what might have been different without ‘at any cost’ values. Consider the Russians; their vision was to win; but what if they had added – not at any cost?  Would they have then said “no” to doping?  Imagine conversations at VW. They were set on being the best performer in emissions but if their board had set the culture of ‘not at any cost’ would the fixing the results of emissions tests still have occurred?

Describing the vision for your organisation is really important to align effort and resources towards the common goal.  However, being clear about the value base for your delivery model is equally important.  What lengths are you prepared to go to?  What risks are you prepared to take?  Where is your “red line” that you will not cross, under any circumstances?  Does all of your governing body or board have the same vision, values and red line?  And what about the staff in your organisation?  Do they have the same vision, values and red line too?  If not, what do you personally need to do to re-dress that situation?

And thirdly, those missed opportunities.  Questions are the core business of being a NED. Good quality questions such as, “How do we know?”  “What else was considered?” “What will we be able to see happening if this works?” “If this starts to go wrong, what is the first sign that we will notice?”  “What do our stakeholders think of this?”

Knowing ‘NHS stuff’ is less important.  In fact knowing less sometimes means you can ask more.

The role of a NED is probably the hardest of all in any organisation.  Organisations frequently don’t really know what they want from you.  Your management team may feel threatened or undermined by the questions, especially if they are unable to answer them. (By the way, it’s a clue that best managers welcome and encourage appropriately challenging questions).  You may be asked to get involved in delivery activity or you may be tempted to roll your sleeves up and get involved in management tasks just because you have the skills and capacity and you can see what needs to be done.  The moment you start to do this you step into the space of our third lesson and you lose your opportunities to ask questions.

And so drawing from these lessons, what attributes and characteristics do I think lay members will need to develop to face the challenges ahead?

Courage – the bravery to do what you know is right, what is in line with your values even when others are suggesting not.

Partnering skills and understanding of the governance between organisations (GBO) agenda- whether for devolution, co-commissioning or for new models of care.  Becoming an expert partner will be critical.

The art, and it is an art, of asking carefully crafted, powerful questions.  Coupled with the skill of listening carefully to the answers, cannot be underestimated.

The ability to be agile, to change tack, to see problems and challenges from a different perspective and to change your opinion when you realise that is what the circumstances demand of you.


This blog is based upon a presentation made to NHS CC lay member national conference 24th November 2015