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.”

Information governance – reducing costs and improving clinical decision-making

According to the Economist Intelligence Unit (EIU), information is the life blood of any modern-day business. Companies succeed or falter based on the reliability, availability, and security of their information. But are most companies properly governing how their information is used, shared, and analysed? The EIU recently conducted a survey of senior executives around the world on the benefits, challenges, and risks associated with developing an enterprise-wide information governance strategy.

The information that companies are busily generating, collecting, and mining offers a wealth of potential benefits. However, its use carries substantial risks. As a result, some organizations are forming formal governance bodies to create strategies, policies, and procedures surrounding the distribution of information inside and outside the firm. The EIU has produced a paper that seeks to better understand how companies are creating crossfunctional governance bodies to create strategies and policies around corporate information.

“Good information governance can help companies solve a fundamental challenge within their organizations – how to balance the costs, risks and value of information assets across the enterprise,” said Chuck Hollis of EMC, a global information management consultancy. “As the EIU research indicates, implementing an information governance program can result in companies seeing improved operations and cost control, increased visibility of information flows across the enterprise and an overall better organizational preparedness for meeting compliance mandates. The senior leadership at corporations worldwide should make this a key business priority.”

Health care organisations feature in the report. Catholic Health, for example, a US$8bn not-for-profit organisation, which owns and operates 76 hospitals and 42 long-term care facilities in the US, says that a company-wide information governance strategy leads to better clinical decision-making. That was the key driver behind their four-year effort to centralise core business functions, such as payroll, procurement, contracting and accounting. Now nearing completion, the effort began with the creation of an information governance committee that comprised operations and technical representatives as well as experts from the clinical, financial and strategic groups, which developed standards for new processes and technology requirements. Chief information officer (CIO) Michael Rowan says that information flow improved dramatically. The consolidation, he adds, saves the company US$75m annually and improves the overall level of care that the organisation provides. “If a patient gets treated at different hospitals in our system and the doctors don’t realise that he or she has diabetes, they could put him or her on an ineffective course of treatment,” explains Mr Rowan. Since clinical information has been centralised, doctors can now track a patient’s history regardless of which CHI facility has treated them. “You can make much more intelligent or even life-saving decisions if you have good information.”

The paper is available for free download here.

Patient Safety First launches ‘How to guide’ for Human Factors

Patient Safety First has produced a Human Factors guide that outlines the concept of human factors in healthcare and provides suggestions of how its elements can be applied by individuals and teams working to improve patient safety. 

Part 1 of the guide focuses on those elements of human factors that require executive leadership such as developing a safety culture and building organisation-wide knowledge of human factors as it relates to patient safety. 

Part 2 focuses on how staff can use knowledge of human factors to make their own daily work environment and activities safer. 

Click here to download a copy of Patient Safety First’s How to guide.

Monitor to practice ‘good governance’?

According to the Health Service Journal (HSJ – 18 June 2009) Monitor, regulator of NHS foundation trusts, might be forced by Department of Health to split Bill Moye’s executive chair job into two – chair and chief executive.

To some it has always been a bone of contention that Monitor should, in its Code of Governance for foundation trust, advocate the “best practice” of separating the roles of chair and CEO, yet fail to follow that guidance itself.

Read the HSJ article here.

Quality of NHS boards needs to improve says Monitor

According to the Health Service Journal (10 June 2009), Monitor says that more needs to be done to boost the quality of NHS boards.

Speaking at an NHS Confederation seminar on board quality, Monitor’s policy director Robert Harris said it was “telling” that a lot of board members were “weeded out” as trusts went through its processes.

Monitor has launched a new training programme for non-executive directors in a bid to improve board functions.

Mr Harris said: “I’d be really pleased if as a result of attending a [training] course some non-executive directors thought ‘this isn’t for me’ and we got a different calibre of person stepping forward.”

He also warned boards were still not considering the right issues: “We don’t look at the right things – we don’t look at the big things.

“How many of us have looked at car parking, ad infinitum?”

But he acknowledged that the regulator needed to change its own focus in order to work best with the NHS as a whole.

Read the full HSJ article here.

New foundation trust NED Development Programme: enhancing board dynamics to deliver strategic change

As part of Monitor’s ongoing commitment to help NHS foundation trusts operate effectively and efficiently, they have launched a Non-executive director Development Programme.

The three-day programme, developed in partnership with the NHS Institute for Innovation & Improvement, is designed to enhance the existing skills of non-executive directors (NEDs) in foundation trusts, and applicant and aspirant foundation trusts. The programme will provide NEDs with the opportunity to:

- develop a broad and comprehensive understanding of the NHS – covering finance and the NHS reform programme;

- enhance board dynamics; and

- understand the strategic challenges facing the health sector.

This programme, which starts in July, is delivered by two leading business schools: Cass Business School and Manchester Business School. The core curriculum is broadly the same across both business schools, however there will be some differences in teaching styles and methodologies. Interested delegates are advised to study both course outlines and select their provider based on their personal learning preference.

For further information on both courses visit www.monitor-nhsft.gov.uk

Irish Health Service Executives publishes its Framework for Corporate and Financial Governance, including risk management

The Health Service Executive (HSE) in Ireland has published its Framework for Corporate and Financial Governance, which includes risk management.

The Framework for Corporate and Financial Governance of the HSE sets out the guiding principles by which the HSE is governed. Document 1.1 outlines the purpose of each of the Framework documents which is divided into two parts:

Part 1 – Board related governance documents which set out the:

Board Terms of Reference (Document 1.2)

Audit Committee Terms of Reference (Document 1.3)

Internal Audit Function (Document 1.4)

Remuneration Committee Terms of Reference (Document 1.5)

Risk Committee Terms of Reference (Document 1.6)

Part 2 – Governance documents of more general relevance:

Code of Standards and Behaviour (Document 2.1)

Good Faith Reporting Policy (Document 2.2 )

Policy Statement on Fraud (Document 2.3)

Integrated Risk Management Policy (Document 2.4)

Procurement Policy (Document 2.5)

Customer Service Charter and Customer Complaints Procedure (Document 2.6)

According to the HSE, “Best practice in the area of governance is recognised as being evolutionary in nature. Standards need to be responsive to the changing environment and will continue to develop and evolve. The standards set out in this suite of documents are the minimum standards of best practice at this time.”

The various documents comprising the HSE Framework for Corporate and Financial Governance, described above, can be downloaded here.

Harrogate foundation trust looking for risk management co-ordinator

Harrogate and District NHS foundation trust is seeking an enthusiastic and motivated person to join the Trust’s Medical Directorate Team. The Risk Management Co-ordinator is a Band 6 pivotal role in the Governance Structure: principally acting as a point of contact for Trust staff, co-ordinating the collection of risk management data, investigating incidents, managing the flow of information and participating in the execution of policy and the practical remediation of problems and incidents.

This is an exciting opportunity for an individual who can work in a fast moving and dynamic environment. You will manage staff within the team and also contribute to external inspections and complaints handling. With a high level of interpersonal, communication and problem solving skills you will be able to assist in the investigation of incidents and contribute to service improvement through effective team work with all levels of staff.

Qualified to degree level or equivalent professional qualification, you will have an understanding of risk and governance with at least 2 years experience in one or more of the fields of clinical governance, risk management, complaints and claims, customer relations, health care practice, legal services or quality assurance. Applications from keen new graduates with strong interpersonal skills and a relevant degree subject will also be welcome.

Download the full job description here.

For an informal discussion please contact Melanie Jackson, Acting Head of Risk Management or Miss Lawson, Director of Governance via 01423 554438.