There are essentially three approaches to the branch of corporate governance that is concerned with ensuring compliance.
The gentlest is a regulatory structure and a light-touch inspection regime: it’s the approach that proved so popular and allowed such innovation within the banking industry.
A traditional middle course relies on audit review: tried and tested, although at times guidance on securing the stable doors can arrive long after the bobtail nag has bolted.
For true assurance, though, you need minders – your own people, on the spot, discouraging mischief. The International Monetary Fund may demand a struggling economy accepts and pays for a consultant or two.
The Department of Health is not averse to helicoptering in a “safe pair of hands” when necessary.
Organisations needing capital – new social enterprises, for instance – may find a new face on the board watching over their funders’ financial interests.
And London clinical commissioning groups must accept “intensive organisational support” and “leadership training” from the likes of KPMG, Pricewaterhouse-Coopers, Ernst and Young and McKinsey, all of which feature on NHS London’s list of approved commissioning partners.
Thirty-one London CCGs have already signed contracts, and the other London pathfinders will surely follow. Despite this year’s quality, innovation, productivity and prevention pressures, £3.7m has been found to pay for the consultants’ services.
The firms in question certainly have expertise. And the Royal College of GPs’ centre for commissioning is reportedly in partnership with the firms, so expect no opposition from the doctors either. The big consultants’ reassuring presence may be the price GPs must pay for their expanded commissioning role.
Reassuring, that is, to HM Treasury.
Much is being made of a parallel DH initiative, Towards Service Excellence.
This proposes a coordinated national approach to support services for commissioning – data collection, clinical procurement, communications and back office functions – and a timetable for transition to “free-standing enterprise”.
Some view it as a device to trim the embarrassing primary care trust redundancy bill.
But for the Treasury, handing £60bn of public money to organisations that still barely exist is a far greater risk. So of course they want trustworthy minders for their investment.