Admiration, Frustration, and Hope: Reflections on My Tenure as a Non-Executive Director at CNWL NHS Foundation Trust

Author: Richard Cartwright | 2nd July

Last Sunday marked my final day as a Non-Executive Director at the CNWL NHS Foundation Trust. As I reflect on this chapter, I am filled with a mix of admiration, gratitude and frustration

Before joining the board, I believed I had a reasonable understanding of the NHS. Having spent nine months, one week, and a day as an inpatient and using many of its community services; I thought I had a pretty decent (lived) experience of the system's inner workings and complexities.?

This rather naive assumption was very quickly blown away. The breadth and depth of service provision is vast and the mechanism by which services are devised, commissioned and delivered immensely and sometimes unnecessarily complex.

The opportunity to work closely with the dedicated professionals of CNWL NHS Foundation Trust has been nothing short of inspiring. The commitment, compassion, and resilience of the staff are truly remarkable. They work tirelessly in an incredibly difficult and constrained environment, often under immense pressure. Their unwavering dedication to patient care is something I deeply admire.

There are inevitably fiscal constraints that face any publicly funded healthcare system. Budget limitations are a reality that requires careful planning and prioritisation.?

Parliamentarians need to level with the public and to be honest about what the NHS can and cannot afford to deliver under current funding levels. Sadly, this conversation seems to have been completely absent from the general election campaign in 2024.

Clinicians will inevitably have their own irritations with the NHS, but as an accountant my greatest frustrations do not relate to funding, they related to some of the absurdities that lay behind-the-scenes.?

Follies that lead to sub optimal outcomes for Trusts providing services and therefore patients.

One-year funding cycles stifle the ability of independent trusts to make long-term decisions; centrally provided accounting rules unfairly allocate scarce capital and thus to drive the choices trusts can make in the delivery of their services; and seemingly random allocations of cash and capital are made available to trust at points in the year where they are then very difficult to spend.

These are completely unnecessary, are harmful and need to stop.

The NHS not only saved my life after my spinal injury but also helped put it back together. The continued support and care I receive from the NHS are crucial for me to live fully and participate in society.?

My belief in the importance of universal healthcare, free at the point of use, remains steadfast. However, we as a society must face up to the inevitable challenges posed by an aging population and be open-minded about how this invaluable service will be provided in the future.

I urge whoever forms the next government to prioritise making the necessary financial and regulatory commitments as well as the autonomy and freedom that allow the NHS to plan in the medium and long term.

Clearly a publicly funded organisation the scale of the NHS needs to be accountable to parliament and the public, but it needs to administered and governed in a manner that befits the long-term nature of a service that supports the population from the cradle to the grave.?

As I step down from my role, I carry with me a profound respect for everyone working within the NHS. It has been an honour to serve alongside such dedicated individuals, and I am grateful for the opportunity to contribute to the CNWL's mission.

Thank you to my colleagues, the staff, and everyone at CNWL NHS Foundation Trust for this incredible journey. Your dedication and passion are the heart of the NHS, and it has been a privilege to be a part of this amazing organisation.

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