Less than 2 per cent of agenda items presented to trust board meetings require decisions, a study of more than 1,000 NHS board papers has found.

Researchers from the Institute of Chartered Secretaries and Administrators analysed the agendas of every NHS trust in England between January and March this year. They found the vast majority of items had no action attached to them, with a tiny fraction explicitly marked “for decision”, ranging from 0.2 per cent in care trusts to 2.1 per cent in primary care trusts.

This increased to 18 per cent if the total number of items marked “for decision”, “approval”, “agreement” or “ratification” were combined, according to the report Mapping the Gap.

The report’s author Louise Thomson told HSJ the 2 per cent figure was among the more “stark” ones to emerge from the research.

“We understand that there is an awful lot that boards have to do in terms of monitoring but we would expect there to be a certain proportion of decision making; only 2 per cent is concerning,” she said.

Researchers also carried out a survey of 176 executives, non-executives and trust secretaries and concluded there was a “disconnect between governance best practice and reality in the NHS”.

For example, while 81 per cent of respondents believed their board achieved the appropriate split between strategic and operational issues – in line with governance guidance suggesting 60 per cent of time should be spent on strategic issues – in reality only 10 per cent of agenda items looked at strategic issues.

The analysis also suggested as little as 4 per cent of board time was dedicated to clinical and quality issues, compared with the recommended 20 per cent.

The report makes eight recommendations for improving governance, including an increased focus on strategic decision making and regular reviews of information presented to the board to achieve “an appropriate balance between historical oversight, horizon-scanning and strategic analysis”.