Good Governance Handbook - HQIP

3. Good governance in today’s NHS
3.1 The context for improved governance
The Government is instituting significant system change in the NHS. Those on NHS
boards, developing new organisations and overseeing service changes have all been
keen to understand how this will affect the way NHS organisations will be governed in
the future. The Secretary of State has said:
“We will not fall into the trap of prescribing top-down processes or
governance requirements to say how this should be achieved.” 3
This makes it clear that accountability for public funds and service provision will rest
with local healthcare organisations themselves. As the Health and Social Care Bill has
been developed following ‘The 2011 Pause’ and the authorisation regime for Clinical
Commissioning Groups (CCGs) has emerged, it is clear that the Government requires a
high degree of accountability and maturity from those leading local NHS
organisations. In 2012 the Department of Health intends to publish a guide for CCGs:
‘Towards establishment: Creating responsive and accountable clinical commissioning
groups’ which, in part, is aimed at helping these groups develop robust governance
arrangements. The new CCGs and other healthcare providers will need to understand
and apply the essential principles of good governance, and find a sensible,
proportionate way of applying these locally. This challenge extends with new players
entering the market in the form of Health and Wellbeing Boards (HWBs) and Clinical
Senates, as well as the continuing challenge of developing accountability systems
within a complex, inter-related care system where a patient’s journey is usually the
joint endeavour of several organisations.
NHS organisations have been extremely agile in the past at taking prescribed models
of governance and finding ways of making them work locally. The challenge is now
different. While there is a degree of central ‘scripting’ of local governance models,
those developing CCGs or developing NHS Foundation Trusts (FTs) need to develop
their own local model which will deliver high local accountability, help fuel innovation
and the achievement of business goals and at the same time sensibly manage risk and
deliver quality and safety. Additionally, as health care is, increasingly, planned and
delivered across pathways of care, good governance within partnerships and across
organisational boundaries becomes all the more critical (governance between
organisations or GBO).
Governance thinking is in part described in law, in part through academic enquiry and
in part from various codes of better practice developed both within the UK and
internationally. The NHS has developed its own codes and recommendations, these
largely being drawn from commercial models. Those developing governance systems
look to these sources, and benchmark better practice in comparable organisations.
3 Liberating the NHS: Commissioning for Patients. A Consultation on Proposals Department of Health,
22 July 010, Gateway ref 14483, p33
www.good-governance.org.uk 5