New Shadow Executive Committee established as permanent improvement

An innovative new model of diverse decision-making has been established to improve heart and lung services at Royal Brompton, Harefield, Guy’s and St Thomas’ hospitals.

The Shadow Executive Committee was launched as a pilot in 2024, to enable a more diverse range of perspectives and views to be heard on key issues discussed by clinical and managerial leaders.

Now, after a year of assessment and feedback, the committee has become a permanent fixture in the Heart Lung and Critical Care Clinical Group (HLCC) at Guy’s and St Thomas’ NHS Foundation Trust. The HLCC Executive Committee oversees the Trust’s adult cardiovascular, respiratory and critical care services across Royal Brompton, Harefield, Guy’s and St Thomas’ hospitals.

Over the past year, the Shadow Executive, made up of 12 colleagues, has made a significant impact, bringing fresh insights and opinions. The pilot concluded in May 2025, and the evaluation highlighted the committee’s successful influence on decisions, the professional development it provided to its members, and its role in enhancing staff engagement across the clinical group.

Central to its success was ensuring that the committee reflected the diversity of HLCC’s workforce and was representative of multiple staff groups. Over 80% of its members were female and over 80% were from the global majority community. Multiple staff groups were represented including medical, nursing, AHPs, admin & clerical and healthcare scientists. The group met monthly to discuss and give feedback to the Executive Committee on key discussions and decisions.

Dan Pembroke, the clinical group’s Chief of Staff who spearheaded the initiative across the clinical group, said: "This scheme has meant we can demonstrate the power of inclusion not just in our decision making, but also in how our staff think and engage with how our organisation is run. What's more, through the evaluation we have data and tools in place to support the spread of this model to those who are interested. The voice of our staff has never been more important in the NHS, and I've been proud of how our Shadow Executive have contributed and grown through the pilot."

Shanaz Ahmed, patient pathway lead at Royal Brompton Hospital and Shadow Executive member felt that not only did her contributions have a profound impact on decision-making but it also had an impact on her personal development: “This experience has broadened my strategic perspective, for example, thinking critically, considering potential challenges and opportunities and understanding the broader context.  It has also helped develop my leadership skills, I have increased confidence in presenting my views and enhanced my networking abilities within the Trust.”

Commenting on her impact on decision-making, Shanaz said: “Participation allowed me to contribute actively to discussions, particularly by providing granular feedback and raising pertinent questions that might not have been apparent from a purely strategic viewpoint.  This often led to a more nuanced understanding of potential challenges and opportunities, ultimately resulting in more informed and effective decisions for the clinical group.”

Grace Shattock, senior medical technologist, at St Thomas’ hospital said she initially applied because she wanted to improve her knowledge of the clinical group and experience how collaborative decisions are made. Grace said: “Through my experience of chairing a meeting, and by taking part in the discussions generally, I feel my confidence in being able to have conversations about different aspects of the clinical group, and the Trust in general, has really improved, which has encouraged me to think about how I can use these skills when trying to progress my career.”

Ifeakor Obumnekeme, radiographer at Royal Brompton Hospital, said: What I’ve enjoyed most about being part of the Committee is the richness of the discussions and the diversity of perspectives shared. It was particularly rewarding to engage in thoughtful deliberations on the papers presented and to see how, despite differing viewpoints, we were able to reach consensus on a wide range of complex issues.”

The Executive Committee endorsed the evaluation of the pilot and approved the embedding of the pilot into the Clinical Group’s governance. Recruitment for the 2025/2026 Shadow Executive Committee is now underway.

The model adopted by the HLCC clinical group was based on the model launched at Oxleas NHS Foundation Trust. To view the full evaluation please contact: gstt.hlccnewsroom@nhs.net.