NHS Governance Review 2015: Uncharted waters

Our fourth annual review into NHS governance, aims to help CCG governing bodies and trust boards assess their arrangements, in the context of the governance and leadership challenges and opportunities set down in the Five Year Forward View, published in October 2014. 'Uncharted Waters' draws on a desk-top analysis of over 200 NHS bodies' 2013/14 annual reports and websites, supplemented by the thoughts of over 110 NHS leaders who responded to our survey and regional workshops on quality governance and integrated reporting.

Many NHS organisations are making good progress on governance, under very difficult circumstances, and the report highlights examples of good practice on innovation, integration and stakeholder empowerment. However, there is also scope to improve integration arrangements to help respond successfully to the challenges affecting the public health and social care system.

Our evidence tells a story of a sector that recognises the need for sea change, which presents a number of key governance challenges and opportunities, such as:

  • governance of leadership, culture and workforce: including the need to deliver high quality, innovative and integrated services under a risk-aware patient-led culture, which is challenging in the current financial and workforce context. The NHS has responded positively to the quality governance issues raised in the three 2013 independent reports and reviews but many Foundation Trusts do not feel well prepared to implement the new well-led Framework.
  • governance in working with others: including accountability issues around collaboration with integrated health and social care stakeholders, difficulties in balancing financial and quality governance with providers, and the transparent management of conflicts of interest in the context of co-commissioning. There continues to be lack of confidence over the comprehensiveness of clinically-led quality impact assessments of main providers' cost improvement programmes.
  • governance of stakeholder relationships: increasing regulatory requirements continuing to drive the length, content and compliance focus of annual reports, diminishing their usefulness as key stakeholder communication vehicles. Engagement is improving but empowerment is far from embedded and there is scope to improve the transparency of disclosures on collective and individual governing body evaluations.  

 The report concludes with a number of questions to help CCGs and trusts assess and challenge themselves on the strength of their current governance arrangements.