Whose NHS is it anyway? Have your say……

Welcome to the place where you can have your say about “whose NHS is it anyway?” The NHS Alliance – the independent voice bringing together everyone in primary health care – wants to know your answer to this question. All views are welcome. To air your views and to find out further information, please click here.

ACCA calls for enhanced training for board members of NHS organisations

The induction and ongoing training available to those responsible for governance in NHS bodies should be evaluated and enhanced to ensure that it meets members’ needs more effectively, says ACCA (the Association of Chartered Certified Accountants) in its report, understanding governance in the NHS, which was recently launched in Westminster.

The report is based on second year results from a three year research project undertaken in collaboration with the Department of Health. Dean Westcott, ACCA vice-president and chief financial officer of West Essex Primary Care Trust, said of the report: “Its findings acknowledge that non executive directors, while widely regarded as valuable in fostering effective corporate governance practice, have insufficient time to fulfil their role properly and are concerned about effectiveness of available induction and training programmes.”

Julia Rudrum FCCA, author of the report and past chair of ACCA’s health panel, said: “The survey of chairs, chief executives and directors of finance of all NHS organisations confirmed that board members were taking their responsibilities20seriously and recognising the need for good governance. But while broadly supporting the guidance issued to date from the Department of Health to provide a framework for developing good governance, the report highlights that knowledge gaps remain and a certain level of confusion exists regarding just what good governance is.”

 Julia Rudrum concludes: “ACCA believes that a clear, principles based corporate governance guide that is useful to all users, but that recognises organisational variations, should be produced to enhance and consolidate existing publications. We also recommend that induction and ongoing training for board members is evaluated to ensure that it is co-ordinated and effective, but that it is also enhanced to meet members’ needs more successfully.”

The report Understanding governance in the NHS – Year 2 can be downloaded here.

Click here for information on the original ACCA Year 1 report.

Non-executive director development programme for existing and aspiring NHS foundation trusts

Manchester Business School, in association with GoodwinHannah Ltd, have developed a residential programme to enhance the contribution non-executives make to their boards. The programme is fully endorsed by Monitor and the NHS Institute for Innovation and Improvement.

The programme is an integrated three day residential event costing £2000 which builds the expertise of directors in four key areas: finance; strategy; clinical quality and organisation culture.

Seven NED competencies will be developed: knowledge of board and role; group decision making orientation; conceptual thinking; communication; clinical performance; board dynamics; and understanding of the health system.

For further information, click here.

“Efficient use of resources and good quality services go hand in hand” – new finance guide for doctors

The Audit Commission and Academy of Medical Royal Colleges have published A guide to finance for hospital doctors.

In the publication, they state that ”there are many examples where clinicians have led change and improved services, through taking greater responsibility for managing the money available to them. This is not about focusing on cost and cost alone, but how best money can be used to improve the quality of care, combining operational and clinical effectiveness. Efficient use of resources and good quality services go hand in hand.”

Healthcare Governance Review believes that the guide, whilst written for doctors, may be of interest to board members and managers.

Download A guide to finance for hospital doctors here.

Health Committee publishes patient safety report

The House of Commons Health Committee has published it final report on patient safety, extending to 120 pages.

Not surprisingly, they criticise the the NPSA’s National Reporting and Learning System as being “limited in its effectiveness” and note that the system does not collect root cause information – a key feature of the design of the System as set down in 2001 in the Department of Health’s Building a safer NHS for patientspublication. The NPSA was established in June 2001, which means that 8 years later the NPSA still has not delivered an effective national reporting and learning system.

NPSA Chief Executive, Martin Fletcher, is quoted in the Health Committee report as saying that ”an undertaking of this scale was a lot more complex than anybody had perhaps at first realised. You have to remember that when this system was set up five years ago it was the first of its type in the world.” Healthcare Governance Reviewfundamentally disagrees. We had the skills, we had the people and we had the technology. Much of what needed to be done had been demonstrably done prior to establishing the NPSA Sadly, the wrong people were put in charge and the rest is history. It is, perhaps, a sobering thought to consider that in the 8 years that the NPSA has failed to get its act together on national reporting and learning, many, many patients will have suffered needless harm or death.

CLINICAL GOVERNANCE

The report appears to be critical of clinical governance. It states at para. 289 that “Boards too often address governance and regulatory issues, believing that they are thereby discharging their responsibilities in respect of patient safety—when what they should actually be doing is promoting tangible improvements in services. The concept of clinical governance may be to blame for spawning a structural approach, focused on processes rather than on the actual state of frontline services.” The fact that the report seems also to be criticising boards for addressing governance issues (i.e. the board performing its proper role!) might indicate that the Health Committee fundamentally failed to understand the concept of governance!

RECOMMENDATIONS FOR NHS MANAGERS AND BOARDS

Readers might be particularly interested in the recommendation made in the report for managers and boards. They are:

- “There is disturbing evidence of catastrophic failure on the part of some Boards in cases such as Maidstone and Tunbridge Wells Trust and Mid-Staffordshire Trust. While other Boards are not failing as comprehensively, there is substantial room for improvement.

- Boards too often address governance and regulatory issues, believing that they are thereby discharging their responsibilities in respect of patient safety—when what they should actually be doing is promoting tangible improvements in services. The concept of clinical governance may be to blame for spawning a structural approach, focused on processes rather than on the actual state of frontline services.

- Many managers and non-executive members of Boards with responsibility for patient safety seem to have little or no grounding in the subject. There is a case for providing specialist training in patient safety issues, particularly to non-executives, to help them scrutinise and hold to account their executive colleagues. We agree with [the] suggestion about giving one non-executive member of each Board specialist training, to allow them to take particular responsibility for it. The example of Luton and Dunstable Hospital in having committees of the Board of Directors to Patient Safety look specifically at patient safety and patient experience should be recommended to all Trust boards.

- Patient safety must be the top priority of Boards. In order to fulfil their duty to ensure “that the quality and safety of patient care is not pushed from the agenda by immediate operational issues”, patient safety should without exception be the first item on every agenda of every Board.

- We commend to NHS organisations the measures piloted as part of the Safer Patients Initiative to ensure that Boards maintain safety as their foremost priority, namely

• implementing tried and tested changes in clinical practice to ensure safe care;
• banishing the blame culture;
• Providing the leadership to harness the enthusiasm of staff to improve safety;
• changing the way they identify risks and measure performance, by using information about actual harm done to patients, such as data from sample case note reviews.

We strongly urge the adoption of these throughout the NHS.

- In addressing the blame culture, we recommend that Trusts use means such as the Texas Safety Climate Survey to measure and monitor how far staff feel confident about being open and reporting incidents.

- We strongly endorse the DH’s view that no Board in the NHS should always be meeting behind closed doors. We urge the Government to legislate as necessary to ensure Foundation Trust Boards meet regularly in public; the public should only exceptionally be excluded.

- Many healthcare workers remain fearful that if they are open about harm to patients they will be unfairly blamed for causing it; and that if they whistleblow they will be victimised. Where information is available about incidents, it is too often not used to make lasting improvements to services. We have insufficient evidence to comment on the adequacy of statutory protection for whistleblowers. However, the information we have received indicates that the NHS remains largely unsupportive of whistleblowing. We recommend that the DH bring forward proposals on how to improve this situation and that it give consideration to the model operated in New Zealand, where whistleblowers can complain to an independent statutory body. We recommend that Annex 1 of the Health Service Circular, HSC 1999/198, “The Public Interest Disclosure Act 1998—Whistleblowing in the NHS” be re-circulated to all Trusts for dissemination to all their staff as a matter of urgency.

- Regarding Mid-Staffordshire Trust, we are unconvinced of the case for a full public inquiry into the Trust, given the work that has already been done by the Healthcare Commission, Professor Sir George Alberti and Dr David Colin-Thomé, and the likely further Patient Safety disruption to the Trust. However, we do see merit in the idea, recommended to us by the Royal College of Nursing, of holding hearings in private to allow members of staff to give evidence confidentially to discover how the state of affairs progressed so far without detection by the Trust Board. As this would look at the past and involve those in post in previous years, it would not impede the process of improvement and the rebuilding of confidence in the hospital. Although held in private its findings should be made public with protection of individual witnesses as appropriate.”

The full report Patient Safety Sixth Report of Session 2008-09, Volume I- Report, together with formal minutes can be downloaded here.

Notable quote: Management Vs (clinical) governance

“The relationship between the governing body and the front line is in essence clinical governance……..management is about running the business, governance is about seeing it run properly.”

Adrian, A (2000). Clinical and corporate governance – salvation or just jargon? Australian Nursing Journal Vol 17 Issue 10

NPSA issues seven patient safety questions for board members

The National Patient Safety Agency (NPSA), in association with the NHS Confederation and NHS Appointments Commission, has published a factsheet that includes a list of seven questions, with supporting guidance, that might usefully be asked by NHS board members to help ensure as part of their role in ensuring the care given in the organisations they govern is safe and risks are reduced.

The seven questions are:

Question 1: Does everyone understand the importance of patient safety?

Question 2: Do we really have an open and fair culture?

Question 3. Are we actively encouraging reporting of incidents?

Question 4. Do we get the right information?

Question 5. Are we always open when things go wrong?

Question 6. Do we learn from patient safety incidents?

Question 7. Are we actively implementing national guidance and safety alerts?

The full factsheet can be freely downladed here.

NHS CEOs: ‘Bold and Old’ – essential board reading from Hoggett Bowers

Executive Search company Hoggett Bowers has published a report on a survey of NHS organisations in England about the length of tenure of their present and immediate past NHS CEOs and Directors of Finance (DoFs). The authors also spoke with a number of Chairs, senior executives, human resource directors and senior clinicians. They hope “that the key messages that have emerged through [the report] will help Chairs, NEDs and CEOs think about how they can work together” and “to stimulate discussion about some of the real challenges facing Boards and senior teams.”

The Health Service Journal reported (HSJ – 18 June 2009), based on the Hoggett Bowers report, that “The “startlingly” high turnover of NHS chief executives and finance directors is discouraging trusts from making the bold decisions needed during an economic downturn.”

The report states that “‘It is highly desirable that effective CEOs remain in an organisation for at least five years. This allows shared purpose to be potentially developed. This flies in the face of David Nicholson’s (CEO of the NHS in England) assertion that “We find it very difficult to recruit people who want to be chief executives – the average time they spend in post is just 700 days.”

Given the current economic climate, this is a report that every CEO and Chair should read. Ideally, either the full or a summary of the report should be shared with all board members leading to a discussion around local implications.

The report – NHS Chief Executives ‘Bold and Old’ – can be freely downloaded here.

IoD policy paper – The Governance of NHS Trusts: Making It Work

The Institute of Directors (IoD) launched a policy paper at an in-house event in London yesterday (29 June) looking at corporate governance in NHS trusts, with an emphasis on NHS foundation trusts.

Speakers at the event included Dr William Moyes, Executive Chair of Monitor, Professor Aidan Halligan, former NHS Director of Clinical Governance and Dr Roger Barker, Head of Corporate Governance at the IoD and author of the IoD policy paper on governance in NHS trusts.

In his talk, Dr Moyes emphasised that “the role of boards is essential in the current circumstances” and reinforced the need for boards to engage in developing themselves to add value to their organisations and using independent advice in their efforts to improve their effectiveness. He said that typical performance problems Monitor had found with NHS boards included:

- Wrong board composition
- Poor board agendas
- Boards getting the wrong information
- Inadequate board behaviour

In relation to the IoD policy paper, Dr Moyes, in response to a question about the volume of governance publications and information from a wide range of bodies to the NHS, said “different perspectives [on board governance] are good and I would like to see more organisations take an interest in boards and corporate governance.” Dr Barker emphasised that the IoD paper helpfully added additional perspectives to the existing Monitor Code of Governance.

Download the IoD policy paper The Governance of NHS Trusts: Making It Work here.

Free July regional workshops – Getting the governance right for clinical treatment decision-making

Between 6 and 17 July, the Good Governance Institute, in partnership with the Institute of Healthcare Management, is running a series of free regional workshops around getting the governance right for decision making in clinical treatment.

NHS organisations increasingly need to make sound, fair and transparent decisions in regard to what treatment will and will not be funded, and to explain why. Patients and clinicians expect NHS care to encompass the best, and these workshops will help participants understand the elements to better practice decision making in regard to funding treatment options. Getting this right is an essential element to the World Class Commissioning process.

The product of these workshops will be a template that will help NHS bodies make better decisions about how care services can be organised, and crucially focus on best practice in the fair, defendable limiting of treatment options.

The workshops are part of the Good Governance Institute’s commitment to providing sound, practical support to NHS clinicians and managers. Taking the example of diabetes care the aim is that these workshops produce generalisable materials to improve the standard of decision making and taking in the NHS.

For further information, download the flyer for these events here.

Fifth Annual Conference – Delivering High Performance NHS Boards

Healthcare Events are running their fifth annual conference on high performance boards in London on Thursday 1 October 2009. This year’s conference has a specific focus on board assurance and early warning systems.

This one day conference provides an important insight into the developments and challenges of delivering high performance NHS boards and the issues affecting you and your organisation.

You will have the opportunity to hear from leading practitioners and learn from experienced trust members about the developments within their organisations, covering a range of techniques, effective systems and mechanisms for delivering high performance at board level, including early warning systems for deteriorating performance. Specific topics include:

- Delivering high performance NHS boards: delivering quality
- Learning from Mid Staffordshire: developing an informed board
- Board accountability and assurance in practice
- Using clinical and performance dashboards at board level
- Early warning systems: avoidable mortality
- Early warning systems: clinical performance and clinical outcomes
- Early warning systems: quality indicators and metrics
- Developing and measuring board performance and accountability for quality improvement and safety in practice
- Developing the role of the non-executive team in oversight

For full details of the conference, including speakers and topics, download the conference flyer here.

HSJ event – NHS risk management, 8 October 2009, London

The Health Service Journal (HSJ) is running a one-day event on NHS risk management in central London on Thursday 8 October.

The event is suitable for clinical and non-clinical professionals, including board members, from all types of healthcare organisation and includes the following topics:

- Developing an integrated approach to risk management effectively assessing risk to safeguard your organisation and all those within it
- Effectively managing risk through responsible monitoring and reporting
- Promoting patient safety through effective risk management and clinical governance
- Integrating workforce health and wellbeing into risk management and occupational health
- Securing business continuity in the event of an unexpected emergency or crisis
- Effectively managing risk across partnerships and organisational boundaries to protect all local stakeholders
- Navigating the commissioner/provider split and its impact on risk management in provider arms

Download the brochure here (registration required).

‘More robust guidance on boardroom behaviours needed’ says ICSA study

The Institute of Chartered Secretaries (ICSA) has published its report on boardroom behaviours which has been submitted to Sir David Walker as part of his review of corporate governance in UK banks.  Sir David Walker’s review will examine board management of risk (including the effectiveness of risk and audit committees), incentives to manage risk in bank remuneration policies, the competences needed on bank boards, board practices and structures, and the role played by institutional shareholders. The review will present preliminary conclusions to commissioning Ministers in the autumn, and make final recommendations by the end of 2009.

The ICSA report, Boardroom Behaviours, follows a study by ICSA of boardroom behaviours , which took the form of a survey and a number of roundtable meetings with company secretaries. The process distilled the considerable knowledge, skills and experience of the company secretarial community on what constitutes good – and bad – boardroom behaviour. Areas covered in the survey included boardroom culture and behaviour, the Combined Code, directors’ skills and resources, disclosure, risk management and the role of shareholders.

In ICSA’s view, best practice in boardroom behaviour is characterised, amongst other things, by a clear understanding of the role of the board; the appropriate deployment of knowledge, skills, experience and judgment; independent thinking; the questioning of assumptions and established views, and a supportive decision-making environment. The degree to which these behaviours can be delivered is shaped, inter alia, by the character and personality of the directors and the balance in the relationship between the key players in the boardroom.

General conclusions from ICSA’s study are that: risk management is not properly overseen, monitored and reviewed at board level; boards generally are not formulating the appropriate risk tolerances of their companies; remuneration and incentivisation are not aligned with shareholders objectives; and disclosure is inadequate.

Specific conclusions are that:

- The absence of guidance on appropriate boardroom behaviours represents a structural weakness in the current system of corporate governance. Had such guidance been available and observed, ICSA argues, the consequences of the current crisis may have been less severe

- Prevention of a recurrence of the events of the last year is at least partly dependent upon more robust guidance on boardroom behaviours being incorporated in the Combined Code

- Better articulation of the business case for best practice corporate governance, and more focus on directors’ responsibilities and potential liabilities, should incentivise directors to exhibit appropriate boardroom behaviours

The Combined Code, ICSA recommends, should be amended to incorporate wording relating to appropriate boardroom behaviours and the business case for pursuing best practice corporate governance. It is also suggested that a best practice guidance note on how boards can improve boardroom behaviour should support the Code.

Download the report ICSA report Boardroom Behaviours  here.

NHS Governance 2009 conference a success

The Health Service Journal’s (HSJ) annual NHS governance conference held over 3-days at Earls Court in London this week attracted over 300 delegates across the different days, with some attending two or all three days.

The conference was a great success with a host of excellent speakers plus good audience participation during panel sessions, etc.

The general state of chaos and confusion around governance and management was a key issue to come out of the event. The speaker from the new Care Quality Commission added to the confusion by saying that “governance relates to consistent management, cohesive policies, processes and decision rights for a given area of responsibility.” This is a new definition that does not align with the myriad definitions already in place in various NHS guidance documents, and does not conform to key thinking about governance. Interestingly, another speaker coined a ‘new’ governance term at the event. Professor Paul Stanton spoke about “intelligent governance.” Healthcare Governance Review looks forward to the day that the subject of governance in the NHS will be addressed ‘intelligently’ by the Department of Health and associated agencies and bodies, including the new Care Quality Commission!

The presentations from the event should be posted on the web for free download by 3 July. When available, download the presentations by clicking here.

BBC Radio Four investigates how the NHS can save money

The BBC Radio 4 Today programme wants to find out practical ideas as to how the NHS can save money from people with first hand experience of the health service.

The have devoted a section of their website to issues around saving money in the NHS. On the site you can listen to an interview with Kings Fund economist John Appleby and Roy Lilley, a former NHS trust chairman, where they discuss how the NHS can be more efficient.

If you work in the NHS, or for an organisation which works with the NHS, the programme wants to hear where you think savings could be made. They will treat your emails in confidence and will not publish any information that could lead to your identification without contacting you directly beforehand.

Access the Radio 4 site here.

BMA report on healthcare associated infections

The British Medical Association (BMA) has published a useful report titled Tackling healthcare associated infections through effective policy action.

The report examines the evidence base for the range of infection control policies, and identify areas for action in tackling the problem.

Whilst the report is intended for policy makers with strategic or operational responsibility for public health in the UK, it will be of interest to board members and healthcare professionals including managers.

The report can be freely downloaded here.

New Irish national standards for infection control

The Irish Health Information & Quality Authority (HIQA) has published its final national standards on infection control following a process of consultation on earlier draft standards. The final standards are a significant improvement on the draft versions.

The new National Standards for the Prevention and Control of Healthcare Associated Infections (HCAIs) are intended to:

- Create a person-centred approach to the prevention and control of HCAIs

- Promote a multidisciplinary and team-based approach within all health and social care services to the prevention and control of HCAIs

- Provide an impetus for the attainment of evidence-based best practice in the prevention and control of HCAIs

- Drive continuous quality improvement through effective management and regular performance monitoring and evaluation of services.

Despite being national standards for Ireland, many healthcare organisations in the UK and internationally will find the standards largely applicable in their context.

Download the HIQA National Standards for the Prevention and Control of Healthcare Associated Infections together with an associated guide to the standards here.

NAO publishes latest NHS infection control report

The National Audit Office (NAO) has published its latest report – Reducing Healthcare Associated Infections in Hospitals in England. This report builds on earlier NAO reports into healthcare associated infection published in 2000 and 2004.

The report points to real progress in dealing with infection control issues in hospitals. But there are still problems to address, including the finding that doctors are less likely to comply with good infection control practice.

According to the NAO “There has been a perceptible change in leadership, performance management and clinical practice in most trusts. The impact has not, however, been the same for all trusts. A quarter of hospital trusts have reduced MRSA bloodstream infection rates by over 80 per cent, but 12 per cent had an increase in MRSA bloodstream infections. Twenty nine per cent of hospital trusts have reduced C. difficile infections by over 29 per cent, but 19 per cent have had an increase in C. difficile infection. Moreover there has not been the same impact on other avoidable infections, where there is still a lack of robust and comparable surveillance information. The information that is available suggests that other healthcare associated bloodstream infections, including ones due to other antibiotic resistant organisms, may have increased. Most staff and patients are less aware of the risks of acquiring these other infections. There is scope therefore for hospitals to improve infection prevention and control further and make savings by tackling other healthcare associated infections.”

Key recommendations for trusts and trust boards set down in the NAO report include:

- Hospital trusts should extend root cause analysis to all serious infection incidents. The Department, Health Protection Agency and National Patient Safety Agency should implement a system for collating and sharing the key lessons from trusts’ analyses in the same way as for other serious patient safety incidents.

- Primary care trusts should require all providers to put in place assurance systems which demonstrate how they are complying with good infection control practice, for example, clinical audit compliance and root cause analysis.

- Hospital trusts should require staff to report healthcare associated infections which contribute to death, significant disability or injury, for one or more patients to the trust’s patient safety incident reporting system.

- Hospital trusts should have processes to provide their board with assurance that infection, prevention and control is the responsibility of everyone in the trust. For example as required by the Code of Practice, all staff should have performance objectives for complying with good infection control practice.

- Hospital trusts should have processes in place to assure their boards that there is effective control over the appropriateness of the antibiotics being prescribed.

- Primary care trusts should monitor hospital trusts’ and other healthcare providers’ antibiotic prescribing and take action to address inappropriate use.

- Primary care trust commissioners’ contracts with healthcare providers should explicitly state expectations of quality and safety with respect to reducing the risk of all healthcare associated infections.

Download the NAO report Reducing Healthcare Associated Infections in Hospitals in England plus associated survey, research and other materials here.

NHS Counter Fraud Service slated after trial collapses

As reported in the Health Service Journal (HSJ – 25 June 2009), the former chief executive of a private hospital group has criticised the NHS Counter Fraud Service and police after his trial for fraud collapsed.

Andrew Breeze, and former finance director Dominic Wilson of  Norfolk, were found not guilty of conspiracy to defraud the health service of more than £2m, at the direction of a judge at Ipswich crown court.

The Crown Prosecution Service had said earlier it would offer no further evidence.

Mr Breeze said the investigation into the case had been incompetent and had assumed he and his co-defendant were guilty.

He said the cost of the three year investigation and seven week trial was likely to be several million pounds.

Mr Breeze, a former board member at a mental health trust with 30 years’ NHS service, said he hoped to return to work in the psychiatric sector.

David Prior, chair of Norfolk and Norwich University Hospitals foundation trust and former chair of Chancellor Care, said the two men had been through three years of utter misery.

Mr Prior was himself investigated by police but not charged. He stood down temporarily as Norfolk and Norwich chair during the investigation.

“It’s a tragedy that it was allowed to get to court,” he said.

“Before the prosecution case was even finished they had to give up.

“People who have not been through this process can have no idea how debilitating it is.

“It is shameful that it was allowed to happen.”

Read the full HSJ article here.

Delivering and demonstrating quality in the NHS – Free HSJ online seminar

The Health Service Journal (HSJ) has produced a free to view 45 minute debate and discussion to help NHS organisations gain the information they need to measure, performance manage and assure quality. The HSJ says it is an opportunity to get to grips with the challenges ahead and help you lead the way in delivering high quality care for all.

The seminar tackles the following issues:

- Establishing appropriate quality metrics

- Securing resources and developing skills to deliver quality accounts

- Embedding quality into contracts through the use of CQUIN

- Determining the reality of reliable information available and steps to improve this

- Ensuring information governance, compliance and risk procedures are robust and fit for the future

Watch the seminar on your computer by clicking here.

Corporate Governance has let us down, says global accountancy body

Corporate governance in general, and not just within financial institutions, “has let us down”, says the Chair of ACCA’s (the Association of Chartered Certified Accountants) Corporate Governance Committee – Professor Andrew Chambers – in a submission to the Financial Reporting Council (FRC).

Responding to the FRC’s Review of the Effectiveness of the Combined Code, ACCA says that while various failures have been blamed for the current economic crisis, corporate governance failures are chief among them.

“Learning lessons from the past is crucial to making strides forward” says Professor Chambers in ACCA’s submission to the Review: “Fine tuning of the current system will not resolve the problems, since it has not done so in the past. For instance, concerns about executive remuneration have continued to grow despite the succession of measures adopted on that matter since Greenbury in 1985.”

ACCA is also concerned about the role of Non Executive Directors (NEDs).

Professor Chambers adds: “A common feature of corporate governance debacles has been that boards, especially their non-executive directors, have been taken by surprise by events. ACCA believes that this is not unconnected to the ability of, and tendency for, top executives to control the flow of information to the board. Many boards seem to operate in a partial assurance vacuum.”

“Central to our 14 page response to the FRC’s Review is the need for the Combined Code to be strengthened in its definition of the requisite training, qualifications, time commitment and conduct of NEDs. If we are to be able to rely on NEDs in the future, they need to be well trained and given proper support.”

ACCA also says there is now an urgent need for the main pillars of UK corporate governance – the FRC, the Financial Services Authority (FSA), Shareholder Bodies, Professional Advisers and Company Law regulation – to determine collectively a better route forward.

The role of shareholders and the bodies that represent them cannot be relied upon either to enforce high standards of corporate governance by companies, since they are not sufficiently organised or incentivised to challenge boards and hold them to account. Furthermore, shareholders themselves often encourage companies to take excessive risks. Therefore, regulation must assume responsibility for ensuring the effective adoption of corporate governance rules.

ACCA considers that corporate governance guidance must in future be applied and enforced much more robustly. It recommends that a project is undertaken, either by the FRC or the Department for Business, Enterprise and Regulatory Reform (BERR), to identify which of the discretionary provisions of the Code should be made mandatory through the listing rules, or by regulation, or by law – with a broader remit than just for listed companies.

Professor Chambers concludes: “Regulation of corporate governance in the UK is currently so light touch as to have very little impact at all; there is a very clear need for more robust regulation in this area.”