NHSScotland publishes Information Governance Competency Framework

In response to the challenges and risks faced by NHS Boards, NHS Education for Scotland and NHS National Services Scotland (NSS) are working in partnership to develop a framework of educational support for information governance. They have recently published Information Governance in NHSScotland: A Competency Framework as a key tool to assist NHS Boards with the planning and implementation of local workforce development initiatives.

The full competency framework can be downloaded here.

Simon Jones on NHS Governance

Writing in the Health Service Journal, Simon Jones, Chair of the NHS Confederation Wales and of Cardiff and Vale Trust, provides some interesting views on NHS governance, and appears to favour the NHS foundation trust governance model as an approach that Wales can learn from.

Read his article here.

Health Care Risk Report Vol 14 Issue 7 June 2008

Governance of primary care trust (PCT) commissioning features in this issue of Health Care Risk Report (HCRR) with an article by Paddy Pearce and Rob McSherry (otherwise known for their excellent book on clinical governance). They believe that “PCTs require knowledgeable, skilled, competent individuals and teams who proactively embrace the principles of transformational leadership, to truly embed integrated governance into commissioning and thus assure the quality of services received by their local population. Commissioning governance” says Pearce and McSherry “can help PCTs provide evidence that they are truly world-class commissioners.”

John Tingle reviews the Healthcare Commission’s second report about complaints in the NHS in England and concludes that the themes and clinical issues identified in the report “are notable in the main for their simplicity and basic nature.” He further concludes that “these are recurring themes year after year. The NHS does not seem to ever to learn the simple, basis lessons of the past.”

Maria Dineen reviews recent National Patient Safety Agency (NPSA) guidance on the use of risk matrices and concludes that whilst the guidance brings together some useful concepts, careful thought is needed when actually using it.

Patient safety also features in this issue of HCRR. An article by Michael Weaver from Bromley Hospitals NHS Trust tells how the Trust has used the Manchester Patient Safety Framework Tool (MaPSaF) to aid compliance with safety standards and to research whether incident reporting rates were associated with perception of safety culture. The tool was found to be useful in revealing a lack of knowledge about incident reporting systems, but some staff felt inhibited in workshops when more senior staff were present. In a separate article by Pat Anderson, editor of HCRR, the national campaigns to improve patient safety in Scotland and Wales are highlighted.

Another article looks at Revising Consent Form 4 in line with the Mental Capacity Act and also in this issue there is the usual generous helping of news and legal case reviews to keep you up-to-date.

If your organisation does not currently subscribe to HCRR then please consider doing so. A subscription form can be downloaded here.

Declaration of interest: Stuart Emslie, editor of Healthcare Governance Review, is on the editorial advisory board of, and is a regular contributor to, Health Care Risk Report.

Irish report on ’system of governance’ for quality and patient safety imminent

According to the Irish Medical Times (18 June 2008) the Department of Health in Ireland has announced that the Commission on Patient Safety and Quality Assurance will publish its report on the licensing of public and private healthcare providers and services in July 2008.  Currently, there is no system of regulation for private healthcare providers.

The Commission will develop proposals for a system of governance based on corporate accountability for the quality and safety of health services, the Department stated. They will apply to both public and private providers, essentially creating one standard. The Commission will also devise:

* a system of leadership for clinicians and managers which would underpin robust corporate accountability for institutional and clinical performance;
* a statutory system of licensing for public and private healthcare providers and services;
* the process of quality assurance of clinical services (with an emphasis on clinical outcomes) for public and private healthcare providers and services;
* procedures for healthcare professionals and managers to anticipate risks and promote good performance through effective risk identification, near-miss and critical incident reporting;
* the governance of regulatory bodies in the health system and ways in which effective integration can be enabled between the various bodies.

Governance Between Organisations debate paper launched

Professor Bryan Stoten, Chair of the NHS Confederation, yesterday launched the Governance Between Organisations debate paper – the second step in the development of integrated governance.

Covering mutual aid, care co-ordination and partnership working the debate paper identifies steps that NHS organisations need to be taking to ensure joined up accountability in an increasingly complex local health and social care market.

The concept of Governance Between Organisationsis predicated on the simple and well known fact that when things go wrong in healthcare, sometimes the problem lies at the interface, or boundary between organisations. The authors state that  “It is just as important to have good governance between organisations as within organisations. A service that stops at the doors of the hospital or when a partner fails to deliver is not really a service, it’s a broken link in the chain of care.”

However, the ‘debate paper’ does seem to miss the point that dealing with boundary risks is a function of management between organisations, not governance. The authors do seem to be mixing up management with governance. And not only that, but there are now so many definitions of governance contained in the debate paper and the original integrated governance guidance that governance appears to have become a confusing term.

For further information on the latest Governance Between Organisations ”initiative’ and to download a copy of the debate paper, click here.

Report raises “serious concerns” about Nursing & Midwifery Council’s governance framework

The Nursing and Midwifery Council (NMC) is carrying out its statutory functions but fails to fulfil these to the standard of performance that the public has the right to expect of a regulator the Council for Healthcare Regulatory Excellence (CHRE) has said in its report on its performance review of the NMC.

The CHRE report identifies serious weaknesses in the NMC’s governance and culture, in the conduct of its Council, its ability to protect the interest of the public through the operation of fitness to practise processes and its ability to retain the confidence of key stakeholders.

The report recommends that the NMC should commit itself to work towards more effective governance. This should include reviewing its committee and accountability structure and agreeing on the level of detail of reporting to meetings. It should also include introducing and enforcing an effective statement of organisational values and code of conduct for Council members and staff, and appraisals for all Council members. Collectively and individually office holders and other Council members should accept responsibility for the current difficulties and for future resolution.

The report further recommends recommend that plans to create a new governance structure for the NMC should proceed as rapidly as possible and sooner than currently planned. There should be no representative members on the new Council and no reserved places for interest groups. All members, whether registrant or public should be appointed against defined competencies and be subject to appraisal. The President should be appointed not elected.

The press release and full report on the performance of the NMC can be downloaded here.

Healthcare Governance Review has previously reported on governance problems at the NMC. For further information, click here.

Department of Health publishes PCT board development specification

The Department of Health has published its PCT board development specification as part of its PCT board development framework, which has the following four strands:

a) Publish a clear specification (this document) which PCTs can choose to use locally (and with other PCTs) to procure a board development programme – by the end of May
b) Put in place a framework of pre-qualified providers with known ability to deliver the board development specification – by the end of August
c) Work with the NHS Institute for Innovation and Improvement to review their current PCT board development diagnostic tool and if necessary update this to fit more closely with world class commissioning – by the end of August
d) Publish a clear statement on the role and constitution of a PCT board, along with a model of good practice – in the summer

The purpose of the specification document is to fulfil part (a) of the four strands outlined above, providing PCTs with a specification that can be used at a local level to procure board development support. The specification will also be used as the basis for the national board development framework (part (b) above); the framework of pre-qualified providers will be available by the end of August.

The specification can be downloaded here.

See also the following Healthcare Governance Review posts:

1. DH seeks ‘expressions of interest’ in the provision of PCT board development
2. ‘Commissioning Assurance’ – Department of Health reinvents ‘controls assurance’ for PCTs

Conference – Delivering High Performance NHS Boards

Healthcare Events is running a one day conference in London on 15 September 2008 on Delivering High Performance NHS Boards. Topic include:

■ Delivering high performance NHS boards: challenges and critical success factors
■ How boards can make a difference to improving NHS performance
■ Lean thinking at board level
■ The NHS Productive Leader Programme: releasing time to lead
■ Using performance dashboards at board level
■ The role of the board in continuously improving quality of care, patient safety and reducing mortality
■ Board accountability and assurance in practice
■ World class comimissioning: critical success factors for boards
■ Developing your skills as an effective board member: experiences in different settings

Two workshops; delivering effective governance between organisations, maximising the contribution of non-executive directors, will provide the opportunity for more interactive learning.

Stuart Emslie, editor of Healthcare Governance Review, will be chairing the conference and is presenting a talk titled Developing high performance NHS boards in practice – from anecdote to evidence-based performance improvement, which will cover the following:

■ how to measure real board performance: It’s about behaviours more than structures and processes
■ the association between board and organisational performance: findings from research studies of NHS foundation trusts and of non-profit hospitals in the USA
■ how boards can make a difference to improving NHS performance
■ practical strategies for evidencing board and corresponding organisational performance improvement resulting from board development activity

For further information, download the brochure for this event here.

The new NHS ‘performance regime’ – dealing with failure

The Department of Health (DH) has published Developing the NHS Performance Regime with the objective of achieving greater transparency and consistency across the NHS in relation to: identifying underperformance; intervention, aimed initially at supporting recovery; and managing failure.

The publication provides a framework for managing the performance of all NHS health care provided, whether that care is delivered in a hospital, in a local GP surgery, or in a community care setting.

According to the DH, “The philosophy underlying our approach is that individual organisations, and in most cases their Boards, are responsible for improving performance and addressing underperformance. In this way, providers, commissioners and SHAs are held to account at organisational level. For example, where a PCT or NHS Trust fails to demonstrate recovery following remedial action, intervention on behalf of the NHS Chief Executive would be aimed at identifying and addressing weaknesses in Board capability and organisational governance.”

The new system means that:

- New minimum standards of quality, safety and financial management will be established and trusts failing to meet these criteria will be identified as ‘challenged’

- The Chief Executive of the NHS will have responsibility for ensuring that all challenged trusts have agreed performance improvement plans with Strategic Health Authorities. These will have defined time periods and milestones against which improvement will be assessed

- Trusts unable to turn around their performance within the expected time period will be determined to have failed on quality, safety or financial grounds and the NHS Chief Executive will then have responsibility for over-seeing changes which can involve removing local management and bringing in a new management team from either other parts of the NHS, NHS Foundation Trusts or the private sector.

The three main options open to the NHS for new management are:

- New NHS management, drawn from [the top management pool]

- NHS Foundation Trust management, deployed to the trusts through a merger of hospitals where an appropriate Foundation Trust is willing to take on this role

- Private Sector management, provided on the basis of a management contract, so that this will involve new management for the trust but no shift of NHS assets or staff to the private sector.

At the same time the DH has set out insolvency principles for Foundation hospitals and non-Foundation Trusts designed to ensure that borrowing does not put NHS assets or the continuity of services at risk.

A further programme of work will be carried out to develop the detail of the vision and will be implemented as part of the 2008/09 Operating Framework. And later this year the DH has said it will publish the quality, safety and financial criteria on which underperformance and failure will be determined and how many trusts are not meeting them. Primary Care Trusts and hospitals will be judged against different but similarly challenging criteria.

Developing the NHS Performance Regime together with a video introduction by David Nicholson, Chief Executive of the NHS, can be downloaded here.

‘Commissioning Assurance’ – Department of Health reinvents ‘controls assurance’ for PCTs

The Department of Health has published its Commissioning Assurance Handbook as part of its World Class commissioning initiative. World class commissioning is about delivering better health and wellbeing for the population, improving health outcomes and reducing health inequalities. In partnership with local government, practice based commissioners and others, Primary Care Trusts (PCTs),supported by Strategic Health Authorities (SHAs), will lead the NHS in turning the world class commissioning vision into a reality, adding life to years and years to life.

The approach being adopted for Commissioning Assurance is highly reminiscent of the Department of Health’s former Controls Assurance process for the NHS. Commissioning assurance will hold Primary Care Trusts (PCTs) to account and will reward performance and development as they move towards so-called ‘world class’. The definition of ‘world class’ will, apparently, continuously evolve, and commissioning assurance will develop in response.

There are three elements of commissioning assurance: outcomes, competencies and governance. Outcomes reflect the overall improvement in the health and well-being of the population. Competencies reflect improvements in the PCT’s skills and behaviours as commissioners. Governance reflects the underlying grip that the Board and the organisation have on their core business. In addition the assessment will review the PCT’s potential for improvement.

The DH says there will be one nationally consistent commissioning assurance system managed by the Strategic Health Authorities (SHAs). As set out in the Operating Framework 2008/09, commissioning assurance applies to all SHAs and PCTs. Within the established annual cycle it will be a consistent assurance system to review PCT progress towards world class performance and achievement of better health outcomes and provide a common basis for agreeing further development. Nationally consistent methodology will, according to the DH, enable reliable comparison of performance across all PCTs.

TheCommissioning Assurance Handbook contains further information and can be downloaded here.

Progress on foundation trust governance and local accountability

Monitor, regulator of NHS foundation trusts, has published a research report showing that NHS foundation trust governors are making local accountability a reality. The report – Developing the role of NHS foundation trust governors – indicates that that the majority of governors are clear about their role, have good relationships with their executive board, and are using their statutory powers to make a difference.

The foundation trust governance model is rooted in local accountability. The Prime Minister has said that he wants to see 3 million foundation trust members by 2012, up from 1 million today, and he wants members to have an even greater say in the workings of their trust.

Monitor has determined, from the research, that there are five opportunities for improving boards of governors:

1. More thorough induction programmes for new governors to help them get to grips with their new role.
2. Improved operation of the board of governors, especially in relation to obtaining appropriate information from trust executives and ensuring informed, productive meetings.
3. Better interaction with the board of directors.
4. Better communication between the board of governors and the membership.
5. More resources to assist board of governors to understand and discharge their statutory duties.

In relation to item 5, Monitor believes it has a leading role to play as the regulator. Monitor’s work in this area will include a review of the NHS Foundation Trust Code of Governance with a view to publishing more specific guidance for governors regarding their statutory duties later in 2008/09.

The report on Developing the role of NHS foundation trust governors can be downloaded here.

Ireland publishes Infection Control Standards

The Health Information and Quality Authority (HIQA) in Ireland has issued, for public consultation, draft national standards for the prevention and control of infections in health and social care settings, such as hospitals, nursing homes and hospices.

The standards, developed by the Health Information and Quality Authority with the input of an expert advisory group, will provide a national framework to improve the performance of healthcare settings in order to reduce healthcare associated infections.

Twelve Infection Prevention and Control Standards have been published which address issues including governance and management; hand hygiene; device related infections, antibiotic resistance, staffing, the physical environment and disease control.

Jon Billings, Director of Healthcare Quality at The Health Information and Quality Authority said; “Infection control is one of the most effective interventions in hospital practice. It helps safeguard patients while reducing costs on the system. Healthcare associated infections are largely preventable, but it requires a comprehensive and co-ordinated approach across the healthcare setting with a culture of hygiene embedded within the organisation.

“Ireland is not alone it its fight against healthcare associated infections – they are a serious concern in every country across the world. The World Health Organization (WHO) for example, estimates that at any given point in time 1.4 million people around the world will have a healthcare associated infection. In Ireland alone the number of MRSA bloodstream infections was 526 in 2007, a drop from 572 in 2006 (HPSC).

“These standards are not just about checking hospitals on an annual basis, but should be the benchmark which all of us, providers and users, expect from our hospitals on a daily basis. That is why we are giving everyone with an interest in this area, the chance to comment.” said Billings.

These are important draft standards and everyone has a right to have their view considered. Therefore, the Authority is now consulting with interested parties and the general public on the draft National Standards for Infection Prevention and Control. Information collected from this consultation will be used to inform the development of the final set of standards which will be launched later this year.

Read the press release here. Download the draft standards here. Download the guide to the draft standards here.

How come we know so little about the outcomes of care in an industry that annually spends £100 billion of taxpayer’s money?

In a thought provoking opinion column article in the Health Service Journal (HSJ), Dr Andrew Jones, group medical director of Nuffield Hospitals and health policy advisor to Andrew Lansley, conservative party shadow health spokesman, says the solution for providers feeling the squeeze has to be quality, and the measures to align the system have to be outcomes.

He contends that open publication of provider performance [based on outcomes] “would put the pride back into services, push clinicians and managers to innovate and give patients a real choice as institutions compete.”

His ”three wishes” for improving the quality of healthcare are:

1. to universally collate independent user satisfaction scores to assess the responsiveness, accessibility and quality of healthcare delivered;

2. to create a quality and outcome performance system for secondary care to measure the outputs of that care, such as readmission or 30-day survival; and

3. to roll out a system of patient-reported outcome measures for all elective procedures and many chronic conditions.

Read the full text of Dr Jones’ HSJ opinion column on health outcomes here.

Welsh Health Circular issued on Corporate Manslaughter

The Welsh Assembly has issued brief guidance on the Corproate Manaslaughter Act for NHS organisations.

The Welsh Health Cricular on The Corporate Manslaughter and Corporate Homicide Act 2007 can be downloaded here.

Foundation Trust Network Conference – From good to great: The governance piece in the FT jigsaw

The Foundation Trust Network (FTN) is holding its first 2-day governance conference for chairs, chief executives, non-executive directors and corporate directors in Leeds on 9 and 10 September 2008.

The conference will explore the challenges of corporate leadership, local membership and accountability, focusing on the opportunity to share across different sectors, debate current issues with peers and learn from the successes and experiences of other foundation trusts.

Stuart Emslie, editor of Healthcare Governance Review, has been invited to lead a workshop on day 1 looking at the relationship between board and organisational performance in FTs based on his research.

For further information about the event, click here.

New book – “Issues in healthcare risk management”

A new book looking at a range of issues in healthcare risk management has been published. The book is a collection of past student work by senior NHS professionals undertaking a masters degree in healthcare risk management at Loughborough University. The book contains fourteen individual chapters covering the following issues:

- Consideration of the essential interacting elements of a risk management system
- A review of the extent to which the Trust Risk Management Strategy is functioning within the Emergency Services Division of an NHS Trust
- The application of a risk management approach in the planning, development and commissioning of an NHS Walk-in Centre
- Implementation of a risk management strategy within the Chronic Disease Management Team of a Primary Care Trust
- Reducing claims against the NHS through the rapid and sensitive handling of complaints
- The relationship between hospital acquired infection rates and the contracting out of cleaning services in the NHS in England
- Reducing the frequency and impact of needlestick injuries involving healthcare staff
- The ageing National Health Service workforce: A significant risk to the NHS and to the nation?
- Violence and aggression towards health care staff
- Fire safety and the training of staff in fire prevention and management in healthcare premises
- The risks and opportunities presented to the NHS by the disposal of surplus buildings

The book is edited by Stuart Emslie, editor of Healthcare Governance Review and visiting fellow in healthcare governance and risk at Loughborough University Business School, along with Charles Hancock, director of health programmes at Loughborough University Business School. The Foreword to the book is written by Professor Shirley Pearce CBE, Vice Chancellor of Loughborough University.

Click here to download a free PDF copy of the book, or purchase the book at cost.