When Nick Williams joined Mersey Care NHS Foundation Trust as a non-executive director in 2014, he did not arrive with a clinical background, a career in the NHS, or any direct experience of mental health services.
His professional life had been spent in financial services, including senior leadership roles at Lloyds Banking Group, working inside large, regulated organisations under constant pressure to modernise, reduce cost and manage risk.
At first glance, it might seem like an unusual route into the NHS boardroom of a mental health trust. For Williams, it became the source of much of his value.
“Banking and the NHS had far more in common than I expected,” he explained. Both are highly regulated and face a huge amount of public and political scrutiny. But at the same time are really focused on driving innovation and efficiency to improve the customer or patient experience.”
Williams originally took on the role as part of his own development and a desire to contribute closer to home in the North West of England. He would end up staying in the role for 11 years. What he discovered was not that banking and healthcare are the same, but that they share enough structural pressures for experience in one world to create genuine value in the other, provided the outsider is willing to learn before they challenge.
Learning what matters
Some parts of the role felt familiar immediately. Governance, finance and risk frameworks were close enough to his day job that he could understand them quickly. What required deeper learning was the clinical side: how quality of care is defined, how it is measured, and what failure looks like when the outcome is not commercial loss, but harm to a person.
“I’m not clinically trained to understand the definitions and measurement of what quality care means,” he says. “So, it was important that I submerged myself into that.”
That became one of his central lessons as a non-executive. An outsider does not need to understand everything. In fact, not knowing everything can be an advantage, as long as they know where their expertise ends.
“In some ways, not having the detail is an advantage coming onto the board as a non-exec,” he added. “I can’t interfere in the quality of the care. What I can do is ask probing questions and challenge based on the data that’s put in front of me.”
“You don’t know what risk management is until you’re making decisions which affect people’s lives.”
The simple questions
Williams believes the strongest non-executives bring governance, strategy, challenge and support without trying to manage the organisation. His own distance from frontline healthcare helped him stay out of operational detail and focus on something different: whether the organisation was thinking clearly.
“If I understand the problem statement, if I can validate what your inputs are, and you’ve gone through a logical thought process, I can be reasonably confident that the conclusion you’re making is going to be a good one,” he explained.
That is where an outsider can be particularly useful. In complex systems, the obvious questions often stop being asked.
“The best questions are always the simple ones,” Williams believes, “because they’re quite often the hardest ones to answer.”
What finance brought to healthcare
Williams’s background in transformation, crisis management, data and digital change gave him a different lens on how Mental Health Trusts think about sustainability. He had lived and worked through the 2008 financial crisis, Brexit planning and the pandemic, and had seen how important it is to stay calm under pressure and make decisions even when information is incomplete.
“Sometimes the worst decision is not making one,” he urged.
His experience as chief digital officer at Lloyds also shaped his view of digital transformation. He had seen how quickly people adopt digital tools when they are convenient, trusted and genuinely useful, but also how human expertise still matters when decisions are high stakes or unfamiliar.
He saw the same principle in mental health. Digital services can make access, communication and routine processes easier, but they should support clinical expertise, not replace it.
At Mersey Care, that thinking sat alongside a wider strategy of growth and scale. “You’re never going to shrink to greatness,” he said.
“I’ve sat through board meetings where everybody in the room was in tears by the end of a family’s story.”
What healthcare taught finance
The exchange, however, was not one way. Williams believes the NHS gave him a deeper understanding of what real risk management looks like.
“You don’t know what risk management is until you’re making decisions which affect people’s lives,” he believes.
One of the most powerful practices at Mersey Care was beginning board meetings with a service user or family story. Sometimes those stories showed the Trust at its best. Sometimes they exposed where care had failed.
“Before you then put your head into a thousand pages, you have the context and the reminder up front why you’re there,” he commented.
For someone used to commercial risk, those stories brought governance back to its human purpose.
Looking back, Williams’s experience suggests the value of an outsider is not that they arrive with ready-made answers. It is that they bring different instincts, different comparisons, and a different way of testing whether an organisation is thinking clearly. For Mental Health Trusts, that can mean sharper conversations about scale, digital transformation and long-term sustainability. For leaders from other sectors, it can mean a much deeper understanding of risk, consequence and public service.
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