Board size and effectiveness

This paper examines the evidence around whether there is a case for moving to smaller councils as a way of delivering more board like and effective governance in health professional regulation.

Introduction

On 7 June 2011, the Department of Health (DH) wrote to the Professional Standards Authority (then CHRE), requesting advice about the efficiency and effectiveness of health professional regulators in delivering a high quality regulatory regime. The letter from DH requested, amongst other things, advice on proposed reforms to deliver greater cost effectiveness and efficiency across the health professions‟ regulatory bodies. This paper is designed as an input to the cost and efficiency work being undertaken by CHRE, and in particular the issue of whether there is a case for moving to smaller councils as a way of delivering more board like and effective governance. It does not deal with the case of moving to smaller councils as a way of constraining costs, since this is being addressed as part of the wider commission from DH.

In answering this question, we have assumed that the status quo prevails in terms of the non-executive membership of councils, and the split between public (lay) and professional membership. Following the proposals contained in the White Paper, Trust, Assurance and Safety, the latter entails, as a minimum, parity of membership between lay and professional members, to ensure that purely professional concerns are not thought to dominate councils‟ work.

The advice we offer in this paper is based on the experience we have gained from overseeing the councils of nine health professional regulators, backed up by literature on a wide range of matters pertinent to the question of board size. It is not intended to be a literature review although a variety of sources are discussed.