Developing inter-organisational governance

On 10 March 2008 Healthcare Governance Review reported on ‘Next steps in healthcare governance – Governance between Organisations’, otherwise known as ‘inter-organisational governance’.

On 24 March 2008 the Health Service Journal (HSJ) published a short article on ’Developing inter-organisational governance.’ Written by the authors of the Department of Health’s Integrated Governance Handbook together with the Chair of the NHS Confederation, the article states that “By now most NHS organisations in England will have reformed their internal governance structures and board effectiveness…….” and begs the question “…just how good is the governance between organisations?”

The article points to a “debate paper” that will be issued in April and will contain the premise that “In our complex world, we cannot operate without the support of others, but partnerships and other relationships bring risks as well as opportunities to both service delivery and our reputation. We must manage these but our board must also seek assurance that risks to our strategic objectives have been identified by our partners with adequate controls in place.” 

Professor Bryan Stoten, Chair of the NHS Confederation, introduces the debate paper thus: “Our current complex and pluralistic world of health and social care requires better partnership arrangements than ever before. Boundary management and boundary bridging can now only work if it takes into account local history, culture and immediate imperatives. This requires, in [NHS chief executive] David Nicholson’s phrase, looking out not up.”

A workshop on ‘Governance between Organisations’ will be held in London on 21 April 2008 - for further information click here.  

The HSJ article on inter-organisational governance can be accessed here.

Achieving financial excellence for NHS boards

In light of increasing clinical and financial demands, the Association of Certified Chartered Accountants (ACCA) and the NHS Confederation have developed an intensive practical training programme that will equip individuals on NHS boards with the key skills that they need to effectively discharge their responsibilities. The 2 day event, titled ”Achieving financial excellence for boards,” costs £790 + VAT per delegate and will be run on the following dates:

23-24 April 2008, ICO Conference Centre, London

2-3 September 2008, ACCA, London

27-28 November 2008, ICO Conference Centre

Further information on the event, including a downloadable flyer, can be obtained by clicking here. 

Freedom of Information Act Commissioner gives warning to the NHS

The Health Service Journal (HSJ) has reported that Hounslow primary care trust’s failure to meet its obligations under the Freedom of Information Act was so severe that the information commissioner Richard Thomas served draft High Court papers to force it to reveal information – the first time this has happened under the act.

Mr Thomas said: “The FOI Act must be properly implemented by public bodies – it is not a voluntary scheme that organisations can dip in and out of. I consider that other health trusts and public authorities could usefully learn lessons from this case.”

According to the HSJ, “The central lesson here is that trusts must ensure their procedures for dealing with FOI requests and their records management systems are up to scratch – a lesson Hounslow has learned the hard way.”

For further information, click here.

Reminder that the Corporate Manslaughter Act ‘kicks in’ on 6 April 2008

The Health Service Journal (HSJ) has, today, published an article on the impending introduction of the Corporate Manslaughter and Corporate Homicide Act, stating that “…different interpretations of the law mean trusts may be unclear about their responsibilities.”The ‘Corporate Manslaughter and Corporate Homicide Act’, which comes into force on 6 April, will mean trusts will become criminally liable for deaths where there is a “gross breach of the relevant duty of care” on account of the way their activities are organised or managed.

Healthcare Governance Review believes that the potential impact of the new legislation on individual NHS organisations can be minimised if trusts:

1. Have in place an effective health and safety management system;

2. Know the extent to which they are complying with a myriad of health and safety legislation and have clear action plans to attain compliance; and

3. Have a clear policy for dealing with potentially lengthy, disruptive and highly intrusive police and/or Health and Safety Executive (HSE) investigations under the Act in he event of the death of  someone where poor management is, or might be to blame.

For further details, click here to read the HSJ article (free registration may be required).

NHS finance director jailed over ‘creative’ accounting

The former finance director of the Mid Essex Hospital Services NHS Trust was jailed for 12 months yesterday when a court found him guilty of a multimillion-pound fraud.

Philip Neal had falsified the valuations of trust land so that it would appear that the trust had generated a surplus rather than a substantial deficit. In his defence he had cited pressure to deliver government financial targets as the reason for his actions.

According to the Daily Mail, Judge Anthony Goldstaub, QC, sentencing Neal at Chelmsford Crown Court, said: ‘It is difficult to exaggerate the importance and value of trust in public life.

‘The public has to be able to rely on its leaders, if not to get things right, then at least to report as accurately as they can and in a reliable way what has been happening.

‘You created a financial illusion greatly damaging that concept of trust and you did so from a high position in an NHS Trust.’

Although the judge said Neal’s actions were not entirely motivated for personal financial gain, they were partly carried out to enable him to ’shine’ as a financial manager. The judge told Neal ‘not to despair’ as he still had an opportunity to rebuild his life after his bout of ‘creative’ accountancy.

Click here to read the full Daily Mail article online.

ACCA reports on a survey aimed at ‘Understanding governance in the NHS’

The Association of Certified Chartered Accountants (ACCA) has made public the results of a survey, undertaken with the support of the Department of Health, looking at governance in the NHS in England.

For a summary of the survey results, provided by ePolitix.com, click here.

Click here for a more detailed commentary of the survey provided on the ACCA website.          

Heathcare Governance Review is awaiting a copy of the full report and will provide a summary analysis of the findings on this site in due course.

Department of Health unveils proposed new ’standards for better health’

The Department of Health is consulting on 18 ‘new’ standards for better health as part of a wider consultation on the future regulation of health and adult social care in England launched yesterday. ‘Risk management and clinical governance’ is the subject of one of the standards.

The 18 standards are arranged into three groups as follows:

GROUP 1 – People’s health and wellbeing are better because the care and treatment they receive are safe and effective

1. Making sure people get the care and treatment that meet their needs safely and effectively
2. Safeguarding people when they are vulnerable
3. Managing cleanliness, hygiene and infection control
4. Managing medicines safely
5. Making sure people get the nourishment they need
6. Making sure people get care and treatment in safe, suitable places
7. Using equipment that is safe and suitable for people’s care and treatment and supports people’s independence, privacy and personal dignity

GROUP 2 – People’s health and wellbeing are better because the care and treatment they receive are personalised and fair

8. Involving people in making informed decisions about their care
9. Getting people’s ongoing agreement to care and treatment
10. Responding to people’s comments and complaints
11. Supporting people to be independent
12. Respecting people and their families and carers

GROUP 3 – People get better care and treatment because systems are operated to manage and deliver safe, effective, fair and personalised services

13. Having arrangements for risk management, quality assurance and clinical governance
14. Keeping records of the provision of care and treatment
15. Checking that workers are safe and competent to give people the care and treatment they need
16. Having enough competent staff to give people the care and treatment they need
17. Supporting workers to give people the care and treatment they need
18. Working effectively with other services

The consultation closes on 17 June 2008. Full information on the consultation can be downloaded here.

Report into Brent PCT £25m deficit finds catalogue of financial management and corporate governance failings

An independent report commissioned by NHS London has found “serious and serial failings” in the leadership of Brent PCT during 2006/07, together with a catalogue of financial management and corporate governance problems. The findings contained in the report, conducted by independent investigator Mr Michael Taylor, include:

- The PCT Board failed, over a number of years, to exercise a competent oversight role in respect of the organisation’s financial affairs.

- The PCT Board failed to ensure that balance existed between its developmental work and executive grip.

- The Non-Executive arm of the PCT Board was culpable of failing to monitor agreed action by members of the Executive Team.

- The PCT’s Clinical and Corporate Governance Committee had very thorough debates about Clinical Governance matters. It did not exercise an effective oversight role of other aspects of Corporate Governance including financial risk and financial standards.

- In 2005 and 2006, the PCT indicated that it was Fully Compliant in the area of governance. These were erroneous Declarations.

- The PCT’s Audit Committee considered many matters in fine detail. This resulted in time being unavailable to ensure that follow-up action to Audit Reports had been properly carried through by the executive members of the Committee. Similarly, the Audit Committee did not drill-down, with regularity, into the underlying financial health of the PCT.

- Appraisal of NEDs was regular and comprehensive. Appraisal of EDs was a more problematical area, with the majority indicating that this task was at best ad hoc.

- Overall, there was “Inadequate Corporate Governance machinery.”

The full report can be downloaded at: www.london.nhs.uk/londonnhs-news.aspx?id_Content=7428

Irish quality and safety conference on April 15/16 2008 focuses on ‘Leading and Managing’

In Ireland, the ’Health Services Quality and Safety Conference’ is scheduled to take place on Monday 14th and Tuesday 15th April 2008 in the Radisson Hotel Dublin Airport, Ireland. The theme of the conference is Leading and Managing and is focused on patient and staff safety and quality. The conference should be of interest to those who have responsibility for resource management and allocation, experts working in the quality, safety and risk management disciplines as well as those who faciliate staff to work in an environment which promotes quality and safety for patients and staff.

Download brochure: Health Services Quality and Safety Conference April 2008

You can also apply online at www.qualityandsafetyconference.ie

NHS Governance 2008 – HSJ conference, 12 June, Manchester

With the strap-line “Strategies to secure robust and fit-for-purpose governance in a constantly changing NHS” this one day Health Service Journal (HSJ) conference aims to allow attendees to:

- Explore the future of NHS regulation
- Gain strategies to develop the intelligent Board and meet their information needs
- Discuss how assurance structures can be improved and appropriately applied at all levels of the organisation
- Explore the implications of the new Corporate Manslaughter Act
- Hear key tips to prepare your governance system for operating in a commercial environment
- Learn how you can create shared governance systems with partner organisations
- Understand how to manage legal difficulties surrounding governance and accountability of Arms Length services

There is a pre-conference seminar on Governance for Foundation Trusts on 11 June. The brochure contains full details of both one-day conferences.

Download a brochure at www.hsj-governance.co.uk

Notable quote – On CEO turnaround……

“Chief Executives who move on every two or three years cannot possibly achieve transformation – turnaround maybe, but not sustained high performance in which all members of staff are engaged and energised.”

Stephen Ramsden, Chief Executive, Luton and Dunstable Hospital NHS foundation trustHealth Service Journal, 20 March 2008, p.26.

Local elected health boards and patients as true paying ‘customers’ – A cure for the NHS?

It’s a trusism that control is usually vested in people who hold the purse strings. Power resides where the money lies. No surprise then that if the government truly want to move from rhetoric to reality on creating a ‘patient centred’ NHS, then patients themselves need to hold the money. They need to become true empowered ’customers’ of the NHS rather than disempowered ‘patients’.

According to James Gubb, Director of the Health Unit at independent social policy think tank Civitas, and author of the report ‘Why the NHS is the sick man of Europe’, the “The long-awaited debate on the future of the NHS has yet to begin.” And the debate needs to consider, as part of the overall answer, the issues such as money coming from patients, and locally elected health boards with the power to set local priorities for directing local resources and healthcare provision.

Read more from James Gubb at: www.yorkshirepost.co.uk/opinion/James-Gubb-We-still-havent.3898122.jp

Healthcare Commission examines governance arrangements for patient safety at NHS Foundation Trust

The Healthcare Commission today (Tuesday) announced that it is to investigate mortality rates at the Mid Staffordshire NHS Foundation Trust. The move is in response to data suggesting that the trust’s rates of mortality may be high, particularly in the area of emergency admissions. The Commission has been concerned about the effectiveness of the trust’s systems for monitoring mortality rates.

Nigel Ellis, the Commission’s Head of Investigations, said: “An apparently high rate of mortality does not necessarily mean there are problems with safety. It may be there are other factors here such as the way that information about patients is recorded by the trust. Either way it does require us to ask questions, which is why we are carrying out this investigation.”

The Commission is pioneering systems that aim to use information to identify potential problems before they become serious. This particular investigation was triggered by an alert system that identifies apparently high death rates.

The investigation will examine the ability of the trust’s information systems to provide an accurate picture of mortality rates and identify potential problems so that swift action can be taken, wherever improvements need to be made.
 
In addition, the Commission will investigate the quality of care at the trust, in particular the care given to older people, following a number of concerns raised by patients.
 
The investigation will also examine governance arrangements to protect the safety of patients.
 
Mr Ellis said:  “It is absolutely critical that, on behalf of patients, we get to the bottom of these issues and bring clarity to the data on mortality rates.
 
“The figures at Mid Staffordshire Foundation Trust are out of normal range which is why we are carrying out this investigation to get a clear picture of what is going on.
`
“People using the trust’s hospital services, should be assured, however, that if we thought the trust was unsafe we would have already taken action. There is no cause for immediate alarm. The safety of patients is our number one priority, nothing will get in the way of this.
 
He added: “The trust is cooperating fully with the Commission and has agreed to provide all information and support that may be necessary throughout the course of the investigation.”
 
“The full results of this independent and thorough investigation will be published in due course, along with any recommendations for improvement, if these are necessary.”
 
The terms of reference for the investigation will published on the Commission’s website www.healthcarecommission.org.uk

UK healthcare regulator agrees a more ‘board like’ governance structure

Following Government recommendations that healthcare-related regulatory Councils become smaller and more ‘board like’, the General Optical Council is to drop from 28 members to 13, with a lay majority. According to ‘Medical News Today’, a smaller, more ‘board like’ Council will mean members will have a more strategic role, and will enable more effective decision-making.

The General Optical Council has approved a ‘person specification’ for members of a the new Council. Attributes of potential candidates will include knowledge and experience of: delivering governance in the public or private sector; financial work in a complex organisation; higher education and training in an optical or non-optical field, and; audit/risk management work in a complex organisation.

For further information, see: www.medicalnewstoday.com/articles/100830.php

New Zealand inquiry finds “sacked” District Health Board failed “the most simple test of good governance”

An inquiry into conflicts of interest at the troubled Hawke’s Bay District Health Board, which was sacked by the New Zealand Health Minister last month, has exposed “very weak systems and processes for determining how conflicts of interest should be managed”. The inquiry was ordered after concerns that the board had “canned plans to contract out millions of dollars worth of community services” following the involvement of a board member in the company that would have been awarded the tender. The report cleared the board member in question of any “illegal or unethical practice.”

In addition to weak systems for dealing with conflicts of interest, ”The review panel found a culture of mistrust and dysfunction between the board and senior management and that is a significant roadblock to good performance.”

Dysfunction, along with a burgeoning budget blowout, was a major factor cited by the Health Minister when he sacked the board last month.

Read the full story at: www.stuff.co.nz/4443044a20475.html

Healthcare Commission identifies over 300 patients in 14 months given “unnecassary dose of radiation”

A report on 329 radiological incidents reported to the Healthcare Commission from November 2007 to December 2007 shows that one in three incidents involve the wrong patient, and reporting of incidents is patchy.

The Commission states that NHS trusts and independent hospitals must ensure the use of x-rays and other radiations is justified, doses are kept as low as possible and incidents are reported where appropriate.

The Commission is currently inspecting around half of the radiotherapy centres in England. It will also be inspecting other healthcare providers where it believes there may be a risk to patients.

While stressing that the majority of cases reported to the Commission involved a low dose of radiation, a third of x-ray incidents (80 in total) involved CT scanning, where radiation doses are at the upper end of the diagnostic spectrum.

Most x-rays and other diagnostic and therapeutic radiation exposures are performed without incident. The number of incidents represent a very small fraction of the total number of procedures carried out – less than 1 in every 88,000 procedures, equivalent to an incidence rate of 0.0113 per 1,000 procedures.

The full report can be accessed at: www.healthcarecommission.org.uk/newsandevents/pressreleases.cfm?cit_id=6325&widCall1=customWidgets.content_view_1&usecache=false

Good governance – What’s wrong with being an ‘Executive Chairman?’

Dr Bill Moyes at Monitor, regulator of NHS foundation trusts, is one. Professor Aidan Halligan, former NHS director of clinical governance, and founder of Elision Health (www.elisionhealth.com), used to be one. But what exactly is all the fuss about being an ‘Executive Chairman’. Read the following short Guardian article and make up your own mind: www.guardian.co.uk/business/2008/mar/12/2?gusrc=rss&feed=business

Acknowledgement: Thanks to Dr Andrew Craig of the MAC Partnership LLP (www.mooreadamsoncraig.co.uk) for spotting this article in the Guardian’s financial pages.

MPs debate allegations of “preventing good governance” at “dysfunctional” Nursing & Midwifery Council

 A BBC news report outlines allegations, made in a House of Commons adjournment debate, of poor governance at the Nursing & Midwifery Council (NMC), the body responsible for regulating around 700,000 UK nurses and midwifes.

According to the BBC report, Livingstone Labour MP, Jim Devine, said: “As a self-governing regulator, whose purpose is public protection in the public interest, the NMC should be run with integrity, competence and transparency.

“Unfortunately this appears not to be the case.

“The NMC appears to be a fundamentally dysfunctional organisation, where the priority of those in charge of the organisation is to maintain the status quo at the expense of proper transparency and good governance.”

He said there appeared to be “an ingrained culture of bullying and racism as a means of preventing good governance in general and, in particular, any proper examination of what is going on”.

The Livingston MP read out testimonies from anonymous whistle-blowers who had been members of the council.

One former member said the NMC had a “culture of institutional bullying” and “domination by a few individuals”.

Health minister Ben Bradshaw responded by saying he took the “long-standing problems extremely seriously” and was asking other regulators to intervene.  Mr Bradshaw said he was asking the Council for Healthcare Regulatory Excellence (CHRE) and Charity Commission to look into the accusations. 

The NMC said it rejected the allegations and welcomed the minister’s intervention.

A spokesman said: “Independent scrutiny will give us a chance to demonstrate that we are a fully accountable, open and transparent organisation which does not tolerate discrimination of any kind.”

The full transcript of the House of Commons debate, together with the NMC’s response, can be accessed here.

Welsh review proposes improvements in clinical governance and patient safety

A report for Powys Local Health Board in Wales has found “a series of serious incidents relating to patient safety in the community hospitals and in two of the Minor Injury Units….” As a consequence, it is being recommended that “In the interests of clinical governance and patient safety, all the acute clinical services in an individual community hospital should be provided by a single NHS trust.”

According to a report by the BBC (see http://news.bbc.co.uk/1/hi/wales/mid/7292712.stm), a Welsh assembly government spokesman said: “The minister is very concerned with the patient safety issues highlighted in the report and has asked the LHB to take immediate action to ensure that services in Powys are made safe.

“Patient safety must be our top priority.”

The full report can be accessed at: www.wales.nhs.uk/sites3/docmetadata.cfm?orgid=501&id=94879

Less than half of health sector organisations have a business continuity plan

According to the Health Service Journal (www.hsj.co.uk – 11 March 2008), a report published by the Chartered Institute of Management and the Cabinet Office found that only 39% of health sector organisations have a business continuity plan. Business continuity is an important consideration in health serives. Driven by the needs of good corporate governance, “Business Continuity Management (BCM) is based on the principle that it is the key responsibility of an organisation’s directors to ensure the continuation of its business at all times.”

 

In the NHS in England, the Department of Health’s Emergency Planning controls assurance standard effectively dealt with the issues of BCM - but the controls assurance standards were replaced in 2004 by the ‘Standards for Better Health’, which make no mention of BCM.

The full report – Business Continuity Management 2008 – can be downloaded at: www.managers.org.uk/listing_media_1.aspx?id=10:347&id=10:138&id=10:11&doc=10:5129

A copy of the controls assurance standard on Emergency Planning (dated October 2002) can be downloaded here: em-standard.pdf