What is a hospital board?

What is a hospital board?

It is the most senior committee that supervises the activities of the hospital.

Hospitals are large or very large and so need to have one. It comprises the  Chief Executive and Executive Directors (who do the day-to-day running of the hospital) and an independent Chairperson and Non-Executive Directors who are both part of the Board and hold their Executive colleagues to account. The whole Board is responsible for clinical, financial and governance standards.

Hospitals only function well with high quality stable boards who have close ties to all levels of staff.

Executive Directors

Chief Executive Officer (CEO)
This is the operational head who manages the services and business of the hospital and implements the decisions of the board. Many will have started as a junior hospital manager; some are doctors or nurses. When CEOs are appointed, they sign a document presented by the Secretary of State for Health which sets out their responsibilities and accountabilities as CEO. This formally appoints them as the ‘Accountable Officer’.

The CEO also, increasingly,  has ‘outward facing roles’, e.g. with liaising with the council, mental health and community trusts, and now the Integrated Care System (ICS).

Chief Operating Officer (COO)
The COO is usually responsible for the day-to-day operation of the hospital, implementing board strategy as well as emergency planning and response. In most hospitals, they also manage the estate and facilities. Clinical Directors (usually doctors who are heads of departments) usually report to the COO because their services are at the heart of the hospitals function.

Chief Medical Officer (CMO; also called Medical Director, MD)

The CMO is a senior doctor who leads doctors in the hospital and is an advocate for patients on the board. They are crucial in driving up the standards of care, clinical safety and governance, and communicating with staff on the front-line.

Chief Nursing Officer (CNO)
The CNO is responsible for all things related to nursing, and usually for the Allied Health Professionals AHPs (physios and OTs etc).

Chief Financial Officer (CFO)
The CFO is responsible for financial management.

[NB. Some boards have other non-voting members e.g. a Head of Strategy. The above five vote on issues if necessary.]

Non-Executive Directors

Chairperson and Non-Executive Directors (NEDs)
NHS Trust Boards are ‘unitary’, i.e. they have collective responsibility for all the work of the hospital. This is quite complex as the NEDs (who come from a range of backgrounds) are both part of the board, but also have responsibility for the public interest, by holding the Executive Directors, including the CEO, to account.

Both the Chairperson and CEO have statutory responsibilities, including for things that go wrong in the hospital. The Chair and other non-executives can hire and fire the CEO.

The board will have several different sub-committees that focus on managing individual aspects of the organisation including Finance and Performance, Quality and Safety  and Workforce.

Talking to them

You should not be frightened of talking to and meeting them. They may be ‘boss bosses’ but are usually very approachable and helpful. Remember they are usually very experienced and became health professionals for the same reason you have, to care for the public. They are often very busy, so booking an appointment via their secretary or PA is a good idea.