Perspectives from an NHS Trust Chair: Why You Should Consider an NED role in the NHS

Tom Hayhoe, Former NHS Trust Chair

Until recently Tom was the Chair of West London NHS Trust, a specialist mental health provider which includes the famous Broadmoor Hospital. He is the former Chair of the acute West Middlesex University Hospital NHS Trust, a former Trustee of the charity Versus Arthritis, and Chair of Gamestation. In his professional career, he was Merchandise Director at WH Smith and a management consultant at McKinsey.

Tom co-founded the Disabled NHS Directors’ Network.

Mark Bate, Head of Healthcare at Nurole, speaks to Tom to gather his thoughts on what it takes to lead in the NHS and how he has managed his disability in doing so. We are privileged to hear his views on the skills required for Trust boards, his advice for first-time NEDs, and his favourite item of stationery...

Why did you become involved in the NHS?

I prefer to answer this by saying “Why have I stuck with it!”. 

I like working on what are intrinsically “wicked problems” to make a difference to my community.

And I like working with the people who make the NHS work day to day, from top to bottom.  From consultant surgeons - who owe their careers to scrub nurses who have saved their careers by saying, “are you sure you should be chopping that leg off and not the other one!” - to theatre technicians, domestic staff, and executive director;  all of whom are equally committed to serving our patients.

What do you get back from being an NHS Chair?

I love the interacting with people and getting patient feedback. When I chaired an acute hospital, we had “captive customers”, either in beds or in the waiting room so, when I had a spare half an hour, I could go down to ask people how they were feeling. It’s not as easy in a mental health or community health setting, let alone a high security mental hospital, but it’s just as important and worthwhile.

I also have a personal satisfaction in doing a job well.  That includes helping new NEDs become effective. Lawyers, for example, face a steep learning curve: they have to switch their mindset from being trusted advisers giving their opinion to influencing by asking open-ended questions of people who know much more than them.

I’ve also enjoyed the relationships with my Chief Executives. You have to work in harness with them, even if you have private disagreements about certain things and are there to hold them to account.

What has been your most rewarding experience?

This is easy: the way staff in my Trust responded during the pandemic. Everyone pulled together and got stuck in - I became a volunteer in the ward because of a staff shortage. Once I donned my mask, apron and gloves, everyone gave the impression that they were able to forget that I was Chair, and I had a great time. 

How do you think your experience enables you to add value?

Boards add the most value when they have people with different skills and backgrounds. 

My experience as a management consultant at McKinsey meant I could learn a new industry quickly and work to solve their problems. When I came into the NHS, I knew how to ask the right questions and put people at ease so they gave helpful responses. 

My other useful experience came from my days as a retailer. Healthcare and retail are both consumer services working in dispersed locations. There are a lot of parallels between the job of ward manager in a hospital and a branch manager on the high street, following protocols, leading staff,  and responding to challenging situations. 

What does a successful board look like? 

I think you need to have both diversity of experience and diversity of outlook. Demographics are an important aspect of diversity but are only part of the picture. For example, you could put Diane Abbott and me on a Board and say you have diversity, but we went to the same university, were taught the same subject by the same people, and are both middle-class Londoners. That’s not the same as having an arts graduate in the same discussion as an engineer. 

I also think you need board members who understand how to behave in the boardroom - an understanding that only comes through experience. Board members need to know when to support and when – and more importantly how – to challenge the executives. Furthermore, they also need to recognise the importance of what goes on outside the boardroom rather than in the formal meeting. They also need to have the confidence to raise issues and stick to their guns when appropriate. 

How has your disability impacted your board career?

I have a hearing impairment. I have colleagues who have more visible disabilities. However, my disability is invisible, so most people don’t know about it most of the time. Disabled colleagues with mobility problems can leave their disability behind once they are seated at the table, whereas my disability only becomes a problem when the meeting starts and people start talking. 

The first thing I do is acknowledge it and don’t try to hide it. Along with my disabled board colleagues, I believe that I have a responsibility to junior colleagues to show that disability shouldn’t be a barrier to developing their careers, but that they shouldn't be afraid to own up to it and ask for support and adjustment so they can thrive.

I also try to make it easy for the people who I am working with. I often start a meeting with someone new by explaining that I am likely to have problems hearing them and that they shouldn't be offended – or embarrassed – when the time comes in our conversation that I will ask them to repeat something.

What advice do you have for aspiring NEDs? 

If you want to be a NED on the Board of an NHS Trust and have no experience of healthcare, or even being on a Board, think about things which may help demonstrate your personal values and fill gaps in your experience – such as becoming a trustee on the board of a charity – and thereby help you get you on the shortlist. 

When you join, get to know your colleagues beyond the Boardroom. There is an assumption that because NHS Board meetings are public, decisions are made in public. Public decisions are always and inevitably informed by the conversations that have taken place outside the Boardroom. 

It’s also important to bring an inquisitive mind and to be prepared to challenge. It’s important to apply critical thinking: if everyone thinks the same, you get unwanted groupthink. If you don’t understand something in the board papers, ask an Executive Director, and if you disagree, warn them in advance rather than spring it on them as a surprise or embarrass them.

Quick Fire Questions:

Favourite dessert? 

Stilton.

Favourite movie?

Casablanca, I can watch it again and again, and it contains almost as many cultural references as Hamlet.

Who is your hero?

As a heavy-duty offshore sailor, I’d go for Robin Knox-Johnston.

Favourite item of stationery?

The Parker Duofold: the pen most international treaties have been signed with. It’s perfectly balanced, beautifully engineered and a work of art.