Integrated Joint Boards – some observations
My Board Watch research project continues. Over recent weeks, I’ve attended a number of Integrated Joint Boards (IJBs) set up to provide governance for Scotland’s Health and Social Care Partnerships.
IJBs are a little different from your average public sector Board –
- There are a lot more people around the Board table. In a recent case I counted 32 in total! With that number you are not going to generate any meaningful conversation unless you employ some dialogic/facilitative methods. Raising a hand when you want to speak and speaking through the Chair is not going to do it. Consequently, conversation tends to be a series of monologues.
- Not all those around the Board table are able to make decisions on behalf of the Board. That’s reserved to sixteen Board members – 8 from the Local Authority and 8 from the NHS.
- There is a kind of revolving door approach to Chairmanship. Chairmanship rotates between NHS members and Local Authority members. But if there is an election, the Chair’s term of office can be less than a year. Unless the Chair is an expert at building trust and relationships that time frame is very short.
- Also interesting is that either body – NHS or Local Authority – can change their appointee at any time during the period of appointment.
- Everyone can speak but very few do. In the first 50 minutes of a recently observed meeting only 4 Board members asked a question, were invited to speak or had something to say.
Given these differences, I thought it might be worthwhile to record my observations specifically on the Integrated Joint Board meetings that I have attended. What I noticed was –
- One or two Board members generally dominate the conversation.
- The more detailed the papers, the more Board members tend to get involved in operational issues that are not the remit of the Board.
- There was a lot of deference for Councillors but not for anyone else. For example, the Chair referred to each Councillor as Councillor X or Councillor Y but addressed every other person by their first name.
- Agreement is often assumed by the Chair. Only one person at a Board meeting I attended last week articulated his agreement to a decision by saying I agree. Everyone else looked down at their papers and said nothing.
- Whenever something was challenged the subject was quickly dropped.
- Board members don’t seem to understand the concept of ‘materiality’ – spending a lot of the meeting time discussing a small saving when the organisation is faced with a potential overspend of nearly 300 times the amount in question seems wasteful. Maybe there are fears that discussing the larger funding challenges would lead to conflict or controversy?
- All of the conversation was about current issues and almost none of it about future strategies or plans – giving the impression that the primary focus is one of survival.
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