A business critical briefing from HSJ’s Fundamentals of NHS Governance conference

Key themes

  • The definition of governance and how it differs from management
  • How sound governance is essential for safeguarding people and organisations
  • The support available to embed governance in NHS organisations
  • Registration with the Care Quality Commission

Action points

  • Shift board focus from the present towards the future.
  • Clarify strategic aims and objectives. Identify strategic risks and align them to strategic objectives.
  • Enhance commissioners’ and providers’ clarity of functions, scrutiny, transparency and probity.
  • Embed sound quality assurance frameworks.
  • Rigorously apply board assurance processes.
  • Understand the CQC system for judging providers. Latest guidance is at www.cqc.org.uk.

Key questions and answers

Q What is corporate governance?

  • Corporate governance is about how organisations take care of themselves. It includes standing financial instructions, standing orders and declarations of interest.

Q Do you think that NHS foundation trust two-tier boards add value?

  • Yes, in principle, but NHS foundation trusts are struggling to demonstrate how. It is easier to hold boards to account when the governors’ board and the board are involved in two-way discussions, so that boards have the opportunity to explain why they have done what they have done.

Q Who has ultimate responsibility for a PCT’s community services?

  • At NHS Enfield, while ultimate responsibility rests with the commissioning PCT, the autonomous provider organisation’s chief operating officer is a member of the PCT board. There are just two joint committees between the PCT commissioners and the autonomous provider organisation - the audit and risk committee and the remuneration committee. There is a memorandum of understanding between the autonomous provider organisation chief operating officer and the PCT chief executive. There are regular informal meetings between the formal PCT/autonomous provider organisation, to identify progress with the challenges and how they are being addressed.

Q Will NHS trusts be required to register more than one location or site with the Care Quality Commission?

  • The CQC wants to minimise the number of locations that are registered. This will be particularly important for ambulance and community services.

Q Will NHS providers be required to identify a registered manager?

  • No.

Q How will the CQC help to reduce duplication?

  • The CQC has a memorandum of understanding with Monitor and the CQC intends to take further steps to reduce duplication.

Patrick Keady is an independent consultant in risk management, governance and safety. He is director at www.betteroutcomes.org and a former NHS trust board director of governance and strategy. Patrick is the first NHS-sourced trustee at IOSH, the world’s largest professional body for chartered safety professionals. He is deputy editor (designate) at RSPHs peer-reviewed Perspectives in Public Health.

Fundamentals of NHS Governance