Professor Sir George Alberti may be a respected clinician, but his report on Mid Staffs, described by Monitor, regulator of NHS foundations trusts as “robust”, demonstrates a clear lack of understanding of the role of boards and the fundamental differences between governance and management.
Of particular note are his recommendations that:
- A member of the Board should be given responsibility as patients’ champion and (s)he or another Board member should have the same role specifically for older people; and
- Patient/public representatives should be included on all Board committees and sub-committees.
On a positive note, however, the report does recommend that “Clinical governance arrangements should be enhanced with strong Board level support.”
Read the report MID STAFFORDSHIRE NHS FOUNDATION TRUST:
A review of the procedures for emergency admissions and treatment, and progress against the recommendation of the March Healthcare Commission report together with Monitor’s response to the report here.
According to a Health Service Journal (HSJ) straw poll, less than a quarter of NHS foundation trusts (FTs) are holding their board of directors’ meetings in public.
NHS chief executive David Nicholson, asked this week whether foundation trust directors should meet in public, told HSJ: “I would hope that over time people would learn the lesson that transparency and openness is far more likely to secure benefits for their patients.
“If you look at where we have had problems, openness would have prevented that, so I encourage them to be more open.”
The Audit Commission has published Taking it on Trust: A review of how boards of NHS trusts and foundation trusts get their assurance.
The report examines how the boards of NHS trusts and foundation trusts in England assure themselves that internal controls are in place and operating effectively.
The report finds that:
- board assurance processes are generally in place to guard against risks but must be rigorously applied
- board members are not always challenging enough
- the data received by boards is not always relevant, timely or fit for purpose
The report includes recommendations for the Department of Health, Monitor and the NHS Appointments Commission, as well as NHS trusts and foundation trusts.
The Commission has also produced a separate briefing, Figures You Can Trust, which reviews current data quality programmes and looks in further detail at how boards assure themselves about the quality of their data.
A number of products are available relating to the report on the Audit Commission’s website:
Taking it on Trust summary - the summary provides an overview of the report and recommendations. Taking it on Trust presentation – the presentation outlines the methodology, findings and recommendations of the report. Checklist for boards – the checklist allows NHS organisations to ask questions about their organisation’s arrangements. Leeds Partnerships NHS Foundation Trust case study – the case study highlights the action taken by the Trust to implement a programme to improve data quality. Plymouth Hospitals NHS Trust case study - the integrated performance report produced by the Trust bringing together performance reporting and the assurance framework
The Kings Fund has published From board to ward – identifying good practice in the business fo caring. Essentially, the report focuses on the role of executive nursing directors on boards.
According to the Kings Fund, “Failure to deliver the fundamentals of care can bring down an NHS board faster than failures of either finance or performance, and there have been recent examples of this. Despite this, there are still serious concerns about the lack of attention some NHS boards pay to the quality of clinical care. However, there have been considerable changes to the external environment over the past year, culminating in the NHS Next Stage Review, led by Lord Darzi………This gives support to the improvement of the quality of care being a business imperative. Such emphasis poses particular challenges for nurse executives. On the one hand, they are well placed to help boards assure themselves about the quality of clinical care. Yet when there are high-profile failings in patient care, it is often nurse executives who are blamed for failing to champion quality and patient safety at board level.”
The King’s Fund, in partnership with the Burdett Trust for Nursing (a charity that offers grants to support the nursing contribution to health care), has developed a programme of work to support nurse executives and NHS trust boards to ‘bring the ward to the board’. It is about turning the spotlight firmly on to reviewing clinical quality, and putting patients and how they experience health care at the heart of an organisation’s work. It set out to explore the role of nurses on the board and how far they were able to influence boards to increase the level of engagement with clinical quality.
This report presents the findings from the first phase of the programme, which was based on seven pilot sites across the UK. The sites included two foundation trusts, a partnership trust, and a primary care trust in England, as well as one site in Northern Ireland, one in Wales and one in Scotland. These pilot sites were chosen for the learning they could contribute about the role of the nurse executive in relation to high-quality, board-level clinical engagement, as well as how to manage patient care and improve the quality of the patient experience. The next phase of the programme, working in another six sites, is already under way and its findings will be reported later in 2009.
Download From board to ward – identifying good practice in the business fo caring here.
Two newspaper stories relating to patient safety are worthy of reporting.
In the first, the Mirror newspaper has published a (’sensationalist’?) story titled NHS cost cutting caused over 2,000 ’serious’ errors last year alone.
The Mirror sent Freedom of Information requests for information on “serious untoward incidents” to all 172 trusts and received responses from 97. Incidents reported to the Mirror included:
- a tube that was helping the patient breathe dislodged, causing a fatal heart attack
- a chest drain being inserted to relieve pressure on the lungs pierced the heart with horrific consequences
- death of a patient given the wrong medication
- missed diagnosis of meningitis led to a child’s death at a hospital
- at another hospital, 23 patients died of C.diff.
- five babies on a neo-natal unit contracted MRSA
- A swab was left inside a patient’s abdomen after a caesarean
The Mirror has produced a ‘glossy’ poster detailing the breakdown of of incidents reported to them by region.
The second story is, in the opinion of Healthcare Governance Review, one that demonstrates responsible newspaper reporting.
Carlisle-based News & Star is an award-winning local newspaper serving North Cumbria.
On 27 March the newspaper ran a story titled “Trust has great safety record.” The story relates to the University Hospitals of Morecambe Bay NHS Trust, which reported incidents to the National Patient Safety Agency within an average of 12 days, when the national average was 57 days. It’s refreshing to see a newspaper taking a positive view of a hospital that is reporting negative patient safety incidents!
New reporting requirements announced on 23 April 2009 will see NHS foundation trusts across England and all NHS organisations in the East of England report on the quality of care their organisations deliver – and how they plan to improve it – as part of their 2008-09 Annual Reports.
The introduction of quality reporting follows a joint consultation by Monitor, NHS East of England, the Care Quality Commission (CQC) and the Department of Health.
According to Monitor, regulator of NHS foundation trusts, “Quality reports will help to develop more transparent and accountable public reporting, ensure that Boards have clear priorities and achievable plans in place for driving improvement, and help to inform the development of Quality Accounts, a legal requirement for all NHS organisations from 2010 as set out in High Quality Care for All.
All NHS foundation trusts in England, and NHS organisations in the East of England, will be asked to:
Produce a quality narrative which provides an overview of the quality of care the organisation offers, its priorities for improvement and how these improvements will be achieved. Patients and the public can use this information to hold Boards to account on the commitments they make;
Respond to any concerns raised about their trust by regulators or representatives of the public (i.e. LINks) and the actions taken to address these concerns; and
Report on their performance in 2008/09 on the basis of indicators chosen by the trust for patient safety, clinical effectiveness and patient experience. In addition to local indicators, the organisation must also report on its performance against national priorities and core standards.”
This issue of Health Care Risk Report (HCRR) contains the usual news, comments and resources along with the following articles:
- A review of complaints handling in the NHS
- Getting GPs involved in patient safety activities
- Advice on research in the NHS involving people who lack capacity to make decisions
- Guidance for NHS organisations on developing a framework for ensuring the competence of staff to deal with cases of suspected abuse
- An article imploring trusts that they should “respond appropriately” to late complaints made by patients and not use the ‘time elapsed’ or ‘ the doctors are now employed elsewhere’ as excuses not to demonstrate compassion.
- An article summarising some of the relative’s evidence to MPs on the health committee in relation to patient safety
If your organisation does not currently subscribe to HCRR then please consider doing so. A subscription form can be downloaded here. You can also subscribe to the free ‘Health Care Risk Report e-zine’ newsletter.
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.
According to a recent BBC news article (23 April 2009), Cotswold Geotechnical Holdings has become the first organisation in the UK to be charged under the 2007 Corporate Manslaughter Act.
The company is accused over the death of employee Alexander Wright, 27, who was killed when a pit collapsed in September 2008. The junior geologist was taking soil samples at a site near Stroud in Gloucestershire at the time.
Company director Peter Eaton is charged with gross negligence manslaughter and could be jailed for life if convicted. The maximum sentence for the firm is an unlimited fine.
Mr Eaton is due before magistrates in Stroud on 17 June. Both he and the company also face health and safety charges.
This prosecution has implications for many other organisations, including NHS trusts, etc. It is vital that all organisations ensure that they are properly managing health and safety at all levels and that all applicable legislation and guidance is adhered to.
Gael Limited, developers of the Q-Pulse compliance management software used by many NHS organisations, have highlighted this matter on their health care discussion forum. Click here to get further information on corporate manslaughter from Gael and to join in the discussion.
Further information on corporate manslaughter, including a detailed Welsh health circular on the subject, available on Healthcare Governancve Review can be found by typing ‘corporate manslaughter’ in the Search box at the top right of the screen.
Monitor, the independent regulator of NHS foundation trusts, has issued for consultation a new document designed to help foundation trust governors exercise their statutory duties.
Governors form an integral part of the new governance structure that exists in all NHS foundation trusts. They are elected by an NHS foundation trust’s members to represent its patients and service users, staff and general public. They do not undertake operational management of NHS foundation trusts; rather they provide challenge to the board of directors and collectively hold them to account for the trust’s performance. Governors are responsible for appointing the chair and non-executive directors of the foundation trust’s board of directors.
In 2007 Monitor commissioned research to investigate how well governors were performing in their new role and what challenges they faced. That research told us that, in the area of discharging statutory duties, governors would welcome guidance and support.
Those findings underpin the guide that has been issued for consultation. It looks at what the statutory powers and duties of governors are, what is required of governors in relation to them and in practice how governors can best meet these challenges.
The consultation on Guide for NHS foundation trust governors: meeting your statutory responsibilities runs for 12 weeks. The deadline for responses is 5pm, Monday 13 July 2009. Monitor intends to publish the final report and a summary of the consultation responses by the end of the summer.
A copy of the consultation document Guide for NHS foundation trust governors: meeting your statutory responsibilities is available for download here.
The trust currently has two employment opportunities.
1. A secondment opportunity has arisen in the Medical Directorate Team to cover maternity leave for a planned period of 7 months commencing June 2009. The trust is looking for a dynamic and enthusiastic person with expertise in the management of claims, complaints and risk to support Corporate and Clinical Business Units in delivering the Trust’s risk management requirements.
2. An opportunity has arisen to manage the Clinical Effectiveness and Audit Department and lead on the trust’s approach to clinical effectiveness and assessment of NICE guidance. We are looking for a dynamic and enthusiastic person with the equivalent of 5 years experience and specialist knowledge of clinical effectiveness or NICE guidance in the NHS.
For an informal discussion please contact Andrea Leng, Head of Risk Management or Dr Gray, Medical Director on 01423 554436. Alternatively, please contact Andrea Leng on andrea.leng@hdft.nhs.uk
Following a damning independent review of management and governance, the Royal Cornwall Hospitals trust has sacked suspended chief executive John Watkinson.
The review found that Mr Watkinson led the trust towards ‘corporate failure’ (click here). A separate review into management and governance at Bromley Hospitals NHS tust, where Mr Watkinson was previously CEO, found ’serious failings’ in the management of the trust and accused Mr Watkinson of breaching certain provisions of the NHS Code of Conduct and Accountability (click here).
The Health Service Journal has produced an article that usefully summarises the results of both the Cornwall and Bromley reviews. Click here.
An interesting article by Calum Paton in the Guardianon 19 April raises the issue of the role of regulation in relation to Mid Staffordshire.
According to Mr Paton “Regarding the Stafford hospital meltdown, we see a ……… “system” of weak and fragmented regulation. Whatever the rights and wrongs of that hospital board’s approach – and it seems to have driven elective targets and finance at the expense of emergency care quality – it was operating in a highly confused regulatory, and indeed policy, system.”
It is interesting to reflect on the role of the principal regulators at the time – the Healthcare Commission and Monitor. What lessons are there to be learned. And what about the role of the National Patient Safety Agency? Whilst not a regulator, with a National Reporting and Learning System (NRLS) that has been over 8 years and more than £10 million in the making, then should it not have picked up something about the state of patient safety in emergency care at Mid Staffordshire – or was Mid Staffordshire not reporting incidents?
The latest in a long line of ‘governances’ in healthcare appears to be ‘human tissue governance.’
The Royal Brompton & Harefield NHS Trust, the largest heart and lung centre in the UK, currently has a vacancy for a Human Tissue Governance Manager.
According to the advert posted in www.jobs.nhs.uk the trust is looking for “a suitably qualified person to promote and ensure compliance with the Human Tissue Act and the Trust’s licensing arrangements with the HTA [Human Tissue Authority].”
Further, the advert mentions that “The post holder should have a scientific or clinical research background and be fully conversant with the provisions of the Human Tissue Act in particular with regard to the use of human samples for research and education. The post holder will also be familiar with audit processes to monitor compliance. With proven interpersonal and communication skills you must be used to working in a busy office and be adaptable to a changing environment.”
Executive search and section consultancy GatenbySanderson has produced an interesting publication – How broad is your board?
The publication highlights the issues and provides insight and advice as to how team profile and composition impacts on a board’s ability to engage across the full range of its responsibilities. Although focused on non-departmental public bodies (NDPBs), Healthcare Governance Review believes that much of the guidance could be applicable in a wide range of organisations.
According to GatenbySanderson, “The right team of non-executive directors is a formidable asset to the organisation at large, and to its sponsor department. However, boards are often recognised for being under-representative across gender, ethnic mix, disability and sector background. So what do we need to consider when making board appointments? How do we ensure that we are attracting, selecting and working with the best people for the role? And how, critically, do we decide where the balance should be between strong, strategic capability and ensuring a broad enough range of experience and perspective?
Download a full copy of How broad is your board?here.
The authors of the Integrated Governance and Governance between Organisations publications, Michael Deighan, John Bullivant and Andrew Corbett-Nolan, are involved in a new book due for publication on 28 February 2010 by Routledge.
Currently titled Governing the New NHS – Issues and Tensions in Health Service Management (sic) the book will build on the authors’ collective experience of their approach to governance that they have been promulgating across the UK NHS.
According to the publisher’s information on the book, “Governing the New NHS makes sense of the new systems and will enable anyone interested in healthcare governance to navigate their way confidently through the confusion. It describes, assesses and critiques the new governance arrangements. It examines how they are working in practice, reporting on how practitioners are making sense of, and responding to, the difficulties and paradoxes that arise. The book:
- Explains current governance arrangements and explores related issues and tensions – such as those between the devolved countries, and primary and secondary care trusts.
- Discusses the roles and interrelationships of boards and effective board practice.
- Debates the nature of effective governance and how to do it well
- Looks at how to ensure seamless governance and service provision in a fragmented NHS – avoiding gaps and problems between different health service providers.”
Whilst Healthcare Governance Review has previously been critical of the authors’ apparent understanding of the distinction betweeen governance and management (e.g. click here and note also the proposed title and strapline for the book, above!), nevertheless this book will undoubtedley be an essential purchase for anyone with an interest in healthcare governance.
Internationally renowned board and Policy Governance specialist Caroline Oliver believes boards are very special in that they have a specific purpose, which is to serve those who put them there – i.e. the organisation’s ‘owners’.
She has written an article titled ‘Ownership and boards’ in which she clearly and succinctly sets out why ‘ownership’ matters; provides assistance to boards to help them identify their owners; differentiates between owners and other stakeholders; and provides insights into ‘making ownership count.’
According to Oliver, ”……ownership is where board leadership starts and where it must come back to in terms of accountability. With a clear common definition of ownership your board will be able to lead together and with confidence. And, with your whole organisation’s future at stake – the work involved in identifying your ownership has to be worth it.”
According to the Patient Safety First team “Tangible evidence of leadership commitment to safety is a fundamental aspect of creating a strong safety culture in any organisation. Ensuring that there is a systematic approach to identifying, communicating and resolving safety related concerns is also critical.”
Patient Safety First have published a comprehensive guide to ‘Leadership WalkRounds’ – a practical and effective tool for patient safety improvement
The Patient Safety First Leadership Team are offering to present the “Leadership for Safety” intervention to Boards in Trusts across England. If you would like to arrange a call to discuss this possibility please email them at info@patientsafetyfirst.nhs.uk
Following the success of her introductory Policy Governance seminars, Caroline will now be leading a two-day intermediate level workshop:
IMPLEMENTING POLICY GOVERNANCE: BOARD EFFICIENCY IN PRACTICE
Manchester Business School
September 30th/October 31st, 2009
The cost of the workshop is £250 (+VAT)
(including a working lunch on both days)
A recent e-newsletter from www.directorsandboards.com asked recipients to briefly outline one big idea that could revolutionise corporate governance. Readers may be interested in Caroline Oliver’s response to the request:
“Stop the intermittent slogging from one “best practice” to the next or, since 1990, from one code to its successor, and start operating from a credible theory of corporate governance. John Carver’s Policy Governance® model being the one example we can cite today.
Overwhelming historical evidence demonstrates that when any field develops, tests, and hones theory is when single steps of improvement become transformation-witness aeronautics, medicine, chemistry, and on ad infinitum. So it will be with corporate governance.”
For further information about Caroline Oliver, click here.
The Health Information and Quality Authority (HIQA) in the Republic of Ireland has published a detailed investigation report into the quality and safety of services and supporting arrangements provided by the Health Service Executive at the Mid-Western Regional Hospital (MWRH), Ennis.
The investigation by HIQA found “serious issues of patient safety” in the area of corporate governance and leadership at MWRH Ennis including:
- A lack of clarity around local accountability and the authority to make decisions with no single person at hospital level who is fully accountable for the quality and safety of services
- Limited systems in place for effective clinical governance in order to provide the necessary assurance for patients
- Risk management processes were not pro-active. Adverse events, complaints and claims processes were not formally integrated within MWRH Ennis and therefore the outcomes from these processes are not patient focused.
The report contends that it is unsafe to keep the service configuration at MWRH Ennis as it currently is. Consequently, in the interests of patient safety and quality, change for safety must happen. The report concludes that the findings are serious issues of patient safety that are at the heart of safeguarding the public and therefore the implementation of these changes is a priority and should not be compromised in the current fiscal climate.
The report provides two interesting, and potentially helpful definitions of clinical governance, viz:
the framework through which all the components of quality including patient and public involvement are brought together and placed high on the agenda of each health organisation; or
the behaviours, and systems and processes which promote accountability and encompass audit policies and procedures risk management incorporating complaints and incident management reporting and monitoring of the quality and safety of services behaviours including relationships and communication leadership of the staff managing and providing care.
The full Report of the investigation into the quality and safety of services and supporting arrangements provided by the Health Service Executive at the Mid-Western Regional Hospital Ennis can be downloaded here.
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