1. Introduction

This framework establishes a more standardised approach to the annual appraisal of chairs, including ICB, NHS trust and foundation trust chairs. The appraisal should be a valuable and valued undertaking that provides an honest and objective assessment of a chair’s impact and effectiveness, while enabling potential support and development needs to be recognised and fully considered. The framework is aligned with the NHS Leadership Competency Framework and informed by multi-source feedback.

We recognise that many organisations have developed and implemented local processes that are equally comprehensive, and which reflect specific contexts and good practice. Therefore, this framework is not intended to be prescriptive. Local variations should be consistent with the framework’s broad principles and include mechanisms for adequate multi-source assessment against the components of the NHS Leadership Competency Framework.  

Context

The framework is informed by the provisions of NHS England’s code of governance for provider trusts, the seven principles of public life (Nolan Principles) and the Financial Reporting Council’s publications (UK corporate governance code and guidance on board effectiveness. These provisions emphasise the pivotal nature of the chair’s role in creating the conditions for the board’s effectiveness in maintaining a focus on strategy, performance, culture and values, stakeholders and accountability.

In 2019, the Tom Kark KC review of the fit and proper person test was published, and this included a recommendation for ‘the design of a set of specific core elements of competence, which all directors should be able to meet and against which they can be assessed’. The NHS Leadership Competency Framework responds to this recommendation and forms part of the wider NHS England Fit and Proper Person Test Framework (FPPT) as the competency and skills benchmark against which board members will individually self-assess as part of the annual ‘fitness’ attestation. We recognise it is unlikely that board members will fulfil all competency areas all the time.

Integrating the NHS Leadership Competency Framework within chair appraisals will enable holistic conversations about performance, values and behaviours and support the ongoing development of chairs and boards. The directory of board level learning and development opportunities supports ongoing development.

The NHS Leadership Competency Framework takes account of NHS England frameworks and strategies and is anchored by core NHS documents.*

* NHS England Operating Framework, NHS National Patient Safety Strategy, NHS Long Term Workforce Plan, NHS England Equality, Diversity and Inclusion Improvement Plan, National Quality Board Shared Commitment to Quality, NHS Well Led Framework, (forthcoming) Insightful Board, The statutory framework of the Health and Care Act 2022.

In leading the board, the chair should set clear expectations about the style and tone of board discussions, ensuring it has effective decision-making processes and applies sufficient challenge in conducting its business. This requires an ability to foster relationships based on trust, mutual respect and open communication between non-executive directors and the executive team, and between the unitary board and its key partners (both internal and external).

As a minimum, chairs should participate in a face-to-face annual appraisal that is informed by self-evaluation and assessments of impact and personal effectiveness from a range of internal and external stakeholders.

The frame of reference for self-evaluation and stakeholder assessment is the 6 leadership competency domains of the NHS Leadership Competency Framework (template provided in Appendix 2). The outcomes from the appraisal discussion will be recorded and shared with the senior appointments and assessment team (SAAT) at england.chairsappraisal@nhs.net to facilitate regional director review (template provided in Appendix 3).

The preparation for and conduct of the appraisal discussion should be facilitated by the senior independent director (SID) or deputy chair. Pending the SID’s appointment in ICBs or trusts where this role does not currently exist, an experienced non-executive director should be nominated via the remuneration committee. The SID or nominated non-executive director (ie the ‘appraisal facilitator’) will be responsible for receiving the chair’s self-evaluation and collating all assessment feedback from the participant stakeholders.

For annual appraisals to be meaningful and contribute beneficially to chairs’ personal development, appraisal facilitators should place significant emphasis on developing a highly functional working relationship with their chairs, built on openness, honesty and trust. This will ensure the appraisal does not feel like an impersonal or isolated annual event but an important cornerstone of continuous and supportive dialogue and objective informal feedback, relating to personal impact and effectiveness. Above all, chairs should be genuinely willing to seek and act on constructive criticism about their impact and effectiveness.

2. Annual process

This framework establishes a standard process, consisting of four key stages, to be applied to the annual appraisal of chairs. The process is described below and presented as a summary flowchart in Appendix 1.

Stage 1: Appraisal preparation   

At a pre-appraisal meeting, the chair and the appraisal facilitator should review the contents of the assessment template (see Appendix 2) and determine whether they will seek feedback for any additional areas: if so, the template will need to be adapted accordingly. Additional areas of focus are likely to be identified by, for example, considering the chair’s previous appraisal outcomes, personal development plan and in-year objectives; key aspects of the board development plan; the NHS Leadership Competency Framework; and the current overall performance of the respective system or organisation.

The chair and the appraisal facilitator should also determine which stakeholders they will invite to contribute to the appraisal through multisource assessment and agree the overall timetable for completing the required appraisal activity. The agreed timetable should ensure all associated stages of the process are completed by the end of quarter 1 in any given year.

Another important part of the preparation is for the appraisal facilitator to speak with their NHS England regional director to ascertain whether they consider that any areas of competency should receive particular focus.

Stage 2: Multisource assessment

Assessments of the chair’s effectiveness should be sought from a range of key stakeholders who represent the organisation and external partner organisations. For foundation trusts, the lead governor (on the council of governors’ behalf) should always be included. For all provider chairs the chair of the ICB should also be included. Other stakeholders might include non-executive directors, the chief executive, executive directors, commissioners and other system partners, patient and public representative leads and a peer(s) from another system or trust(s). Careful consideration should be given to ensure there is an appropriate number and span of representative participants.

Concurrently, the chair should be invited to conduct a self-assessment using the chosen criteria included in the multisource assessment template (see Appendix 2). This self-evaluation should include commentary on any identified personal development or support needs.

Stage 3: Evaluation

The appraisal facilitator will need to devote sufficient time to evaluating all the collated stakeholder assessments. As part of this, it may well be necessary to seek further information from one or more of the assessors, to gain greater insight and/or to clarify certain areas. The evaluation of stakeholders’ views should then be considered alongside the chair’s own self-assessment. Again, the chair may ask the appraisal facilitator for further information and/or comment.     

Stage 4: Appraisal output

The collective evaluation of the multisource assessment should form the basis of, and subsequently guide, an appraisal discussion between the chair and the appraisal facilitator. During the discussion, equal consideration should be given to assessing in-year performance, how any previously identified development and support needs have been met, identifying any continuing or additional development or support required, and determining key objectives for the current year.   

The key points arising from the appraisal discussion should be formally recorded by the appraisal facilitator and agreed by the chair. A template is provided in Appendix 3.  

After completing all local activity, a copy of the appraisal reporting template should be sent to the Senior Appointments and Assessment team (SAAT) at england.chairsappraisal@nhs.net to facilitate regional director review. Once approved by the regional director, SAAT will send it to NHS England’s Chief Operating Officer for review (and for ICBs and NHS trusts, endorsement). NHS England’s Chief Operating Officer will exercise discretion in seeking further information and/or moderating the appraisal outcomes, if such action is deemed necessary.

Appendix 1: Process for annual appraisal of NHS chairs ‒ summary

Appendix 2: NHS chair multisource assessment template

Overview

This template is for those asked to contribute to the annual appraisal of NHS chairs, a principal component of which is multisource assessment. In addition to inviting responses from identified stakeholders to the statements and questions in the template, chairs will be asked to reflect on the same statements and questions as a means of self-assessment. The collective evaluation of all responses, including those provided by chairs, will form the basis of an appraisal discussion conducted by the appraisal facilitator. 

The outcomes arising from the appraisal discussion will be formally recorded and, for ICBs and NHS trusts, reviewed at regional level (by respective regional directors) and national level (by NHS England’s Chief Operating Officer).

The annual appraisal process should be a valuable and valued undertaking that honestly and objectively assesses a chair’s impact and effectiveness, while enabling potential support and development needs to be recognised and fully considered.

The NHS Leadership Competency Framework contains six domains:

1. Driving high-quality, and sustainable outcomes
2. Setting strategy and delivering long-term transformation
3. Promoting for equality and inclusion, and reducing health inequalities
4. Providing robust governance and assurance
5. Creating a compassionate, just and positive culture
6. Building a trusted relationship with partners and communities

Collectively, the competencies associated with each domain represent a success profile against which chairs’ impact and effectiveness should be annually assessed. 

The multisource assessment template consists of themed statements grouped according to the six competency clusters. Based on their direct knowledge of the chair, assessors are asked to provide a response to each statement or to a smaller number of specific statements that will have been indicated by the appraisal facilitator. 

Assessors are further invited to provide commentary in response to 2 questions: “what does the chair do particularly well?” and “how might the chair’s impact and effectiveness be improved?” Responses will be particularly valuable in highlighting areas of high impact and good practice, and opportunities for development and support.  

Completed templates should be submitted (anonymously or otherwise) direct to the appraisal facilitator.

Multisource assessment – impact and effectiveness

Download a word version of the multisource assessment – impact and effectiveness template.

Appendix 3: NHS chair appraisal reporting template

This template should be used to formally record a summary of the key outcomes from the appraisal discussion between chairs and appraisal facilitators.

Download a word version of the NHS chair appraisal reporting template.

Publication reference: B0496iii