High-profile NHS reforms present a number of challenges and opportunities to governance arrangements across the health service, which need to respond to changing models of care.
Recent announcements including plans to devolve NHS funding in Greater Manchester to the announcement of 29 vanguard sites to test new models integration has put renewed focus on governance arrangements in the health service.
Grant Thornton’s recently completed annual review of NHS Governance examines the current governance-related challenges and opportunities facing the NHS. Taking in to account the Five Year Forward View changes, the review finds a need for the NHS governance and risk management arrangements to be more agile.
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.
With all of this in mind, the headline findings from the review include that greater clarity on accountability and delegation on integrated health and social care is still required. Integrated health and social care issues remain, with the main governance risks associated with increased pooled funds are seen to be unclear lines of accountability, according to 82% of 116 senior health service leaders surveyed, and control over outcomes (71%).
The NHS leaders interviewed for the study felt that the weakest collaborative relationships and partnership governance arrangements exist with Healthwatch, social enterprises, third sector organisations and the private sector, whilst they were stronger with Clinical Commissioning Groups. Meanwhile, just 12% of health and wellbeing boards have mental health trust member representation. In the context of the Forward View and emerging care models it is critical that governance arrangements of all partners are enhanced.
In addition, stakeholder engagement is improving but empowerment, the key aspiration of the Forward View, is not yet in place. Overall, 95% of respondents believe the governing body or board provides clear guidance to all staff, patients and stakeholders on the strategic and operational quality outcomes it expects. However stakeholder empowerment is still far from embedded. More than a third of respondents say they have not engaged with the public on what information is needed on quality of services, finance and governance. NHS organisations need to implement more effective strategies if they are to achieve the Forward View vision of empowered patients and communities.
In addition, the development of a well-planned, trained and empowered workforce represents a huge challenge for local leaders. Although there has been a slight improvement since last year, a quarter of our survey respondents (25%) still say their organisations do not have robust arrangements in place to develop the capacity and capability of employees. These findings highlight 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.
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.
It is our belief that agile governance, mature risk management and genuine empowerment can support key Forward View pledges to boost innovation and the use of information revolution, and developing a modern workforce.
Paul Hughes is the public sector governance lead at Grant Thornton UK
