The findings of a new study from Grant Thornton UK LLP demonstrate a need for improved partnership governance to strengthen collaborative working across the NHS.
The Uncharted Waters study shows that only 15% of NHS leaders believe they have strong or embedded collaborative governance arrangements – a worrying deficit in the context of its key role in new care models proposed by the NHS Five Year Forward View.
NHS leaders interviewed for the study (see methodology below) felt that the weakest collaborative relationships and partnership governance arrangements exist with Healthwatch, social enterprises, third sector organisations and the private sector, whilst there were stronger with Clinical Commissioning Groups (CCGs). Meanwhile just 12% of health and well-being boards have mental health trust member representation.
The analysis also shows that ‘people’ features in the top three strategic risks of 12% of NHS organisations, having moved from 6% – the biggest annual leap of any risk area.
Bill Upton, Head of Healthcare at Grant Thornton, said:
"Many NHS organisations are making good progress on governance, under very difficult circumstances. Our report highlights examples of good practice on innovation, integration and stakeholder empowerment.
"Devolution and new models of care are now truly underway and, with Greater Manchester announced as the first region to be given control of its own NHS budget, we are likely to see more regions and local health economies follow suit. As this continues it is vital that NHS organisations work together, and in partnerships with their stakeholders, to ensure risks and opportunities are managed and underpinned by solid governance practices.
"Our evidence tells a story of a sector that recognises and embraces the need for sea change, which at the same time presents a number of key governance challenges and opportunities."
Paul Hughes, Public Sector Governance Lead at Grant Thornton, added:
"Effective collaboration must be underpinned by good governance if quality and financial sustainability challenges are to be met. It is still early days for the new arrangements but clearly more needs to be done to ensure NHS organisations are working together effectively to improve local health economy outcomes.
"The new well-led framework introduced by Monitor, which is being aligned to other regulators' governance assessments will test leadership, management and quality governance. Whilst there is recognition that its implementation will strengthen quality governance arrangements yet two thirds of foundation trusts say they are not fully prepared to implement the framework.
"Our research also highlights the growing concern that NHS organisations have about skills shortages and talent retention. In this period of change and uncertainty it is imperative for NHS organisations to ensure that their people are nurtured and empowered to bolster retention and drive the changes needed."
Taking in to account the Five Year Forward View and the Dalton Review , the study is set in the context of current governance-related challenges and opportunities they present to the NHS. It also acknowledges some of the key integration solutions highlighted in Goldberg III.