1st May 2009
By Alex Klaushofer
Board members on NHS trusts are ‘too trusting’ and fail to scrutinise information that could reveal major failures in patient care, auditors have found.
According to Taking it on trust, a report from the Audit Commission published on April 29, there are significant gaps between the processes designed to safeguard against risk in hospitals, and the rigour with which they are applied.
The commission criticised members sitting on hospital and foundation trust boards for not being sufficiently prepared to challenge the information presented to them, which could be inadequate or out of date.
‘In the worst cases, the assurance process had become a paper chase rather than a critical examination of the effectiveness of the trust’s internal controls and risk management arrangements,’ the report said.
Audit Commission chief executive Steve Bundred told Public Finance: ‘In most cases, the processes were in place, but in some cases people were going through the motions in terms of applying them.
‘There’s a culture of trust in the NHS. What we’re saying to board members is that they need to be a bit less trusting, and a bit more sceptical,’ he added.
The study followed concerns expressed by foundation trust regulator Monitor about the gaps between statements made by trusts for regulatory purposes and what happened in practice.
‘Monitor relies on boards to be the front line of regulation,’ said executive chair Bill Moyes. ‘For boards to do this requires them not only to have the right information, but also assurance that it is accurate, relevant and reliable.’
In March, a report by the Healthcare Commission attributed ‘appalling standards’ of emergency care at Stafford Hospital to an obsession with targets. It said this stopped senior managers addressing problems such as low staffing levels, poor patient care and lack of equipment.
The Audit Commission report was published in the week that the Care Quality Commission announced the introduction of a rapid response system to help health and social care regulators identify potential problems.
Jamie Rentoul, CQC’s director of regulation and strategy, said: ‘The various regulators and oversight bodies involved in health and adult social care each hold a wealth of information on the quality and safety of care in services across the country. We want to make sure that we can bring this information together and that where patterns of poor performance emerge, action is taken swiftly.
‘We will look for emerging patterns, such as problems with particular services or recurring issues in the area.’
The chief executive of the NHS Confederation urged all hospital leaders to examine the culture of governance in their organisations.
Steve Barnett said the best boards in the NHS were the ones where senior leaders did not rely simply on box-ticking checks but where there was a genuine, day-to-day understanding of what was happening in their organisations.
‘It is absolutely vital that hospital leaders are fully connected to what is going on in all parts of their organisations – and that means adopting the questioning and sceptical approach to information, which the Audit Commission is calling for,’ he said.
‘Boards need to have robust systems in place to tell them what is going on and the right structures in place to identify risks and manage them. They need good quality data allied to a management culture where leaders feel comfortable walking the wards and asking difficult questions.’
He said that board members in the best organisations ‘do not just believe something because they read about it in a report – they base their judgements of what the situation is on the ground by actually getting out and experiencing it for themselves’.
