NHS Governance Study day, 17 November, London

Join expert speakers for “an essential, one-stop guide to the ins and outs of NHS governance.”

The Health Service Journal is running eight key information sessions, over one study day, on 17 November 2009 in Central London.

The information sessions/speakers are: 

- Linda Hutchinson, Director of Registration at the Care Quality Commission to gain a comprehensive overview of what this new era of regulation will mean for NHS governance systems
 - Get to grips with quality assurance – hear from Lynn Betts, an Independent Consultant from Quality Governance Limited, and the first ever NHS Director of Governance
 - Gain a comprehensive understanding of clinical, corporate and information governance and examine how they interact from Stuart Emslie, Assistant Director of the Centre for Corporate Ethics at Birkbeck London University and Visiting Fellow at Loughborough University Business School
 - Join a team of board level development experts – Jay Bevington and Sai Shanmugarajah from Deloitte and Deborah Arnot and Deborah Chafer from NHS North West Leadership Academy – and hear what more can be done to support board level development in your organisation
 - Understand what good integrated governance looks like and how it works in practice. Hear from Brian Terry, Head of Integrated Governance for NHS Gloucestershire about the fundamental differences between the current and historic systems of governance
- Gain an insight into how the delicate tensions of PCT governance can be balanced and what PCT governance will look like post-divestment with a presentation from Enfield PCT
- Explore the new demands on governance systems which come with the achievement of FT status in a session devoted to securing your understanding of FT governance
 - With NHS governance systems increasingly having to transcend organisational boundaries, the systems and processes of governance between organisations have never been more important. Hear how to overcome the challenges of governance between organisations from Dr John Bullivant, Director of the Good Governance Institute

According to the HSJ, this essential day gives you the unique opportunity to really understand the ins and outs of NHS governance.

For further information on the event, and to secure your place, click 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.

Forthcoming book – Governing the New NHS

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.

For further information, click here.

Forthcoming HSJ Governance Challenge and 5th annual NHS Governance conference

Looking ahead to 2009 and beyond, immense challenges can be seen which will test even the most robust NHS governance systems. The Health Service Journal (HSJ) has lined up a number of exciting events in March and June. Click here for further information on the HSJ Governance Challenge and pre-study day Fundamentals of NHS Governance (24/25 March 2009 in Birmingham) and click here for details about the 5th annual HSJ NHS Governance Conference (23-25 June, London). Don’t miss these important events.

View presentations from HSJ conference ‘Intelligent information for effective governance’

The Health Service Journal conference Intelligent information for effective governance, held on 22 January 2009 in London, attracted around 170 people and was a great success.

Speaker presentations are now available for viewing by clicking here.

Fundamentals of NHS governance – forthcoming one day Health Service Journal event

Watch out for a forthcoming one day event in Birmingham covering the fundamentals of NHS governance organised by the Health Service Journal (HSJ).

Healthcare Governance Review has seen a draft of the programme for the event, which includes:

- The Care Quality Commission and regulation
- Quality assurance
- Clinical, corporate and information governance
- Integrated governance
- Board level development
- PCT governance
- Foundation trust governance
- Governance between Organisations

Speakers will include:

- Professor Paul Stanton, Northumbria University
- Dr Jay Bevington, Deloitte
- John Wilson, NED, East Riding and Yorkshire PCT
- Stuart Emslie, editor, Healthcare Governance Review

Further information, when it becomes available, can be found here.

Intelligent Information for Effective Governance – HSJ conference, London, 22 January 2009

Readers are reminded that the Health Service Journal (HSJ) is running a conference on Intelligent Information for Effective Governance – Developing smart systems to empower strategic decision-making at board level, on 22 January 2009 in London.

According to the HSJ, good governance is underpinned by intelligent information. There is a tendency across the country however, to overload the Trust Boards with too much information, hindering their ability to function effectively. This is a key challenge for many Boards – especially with the implementation of the new NHS performance framework, and the emerging threat of the NHS failure regime.

This conference has been specifically designed to provide delegates with the tools and guidance they need to streamline and strengthen information flows to Trust Board, and ensure accuracy, quality and relevance of information for strategic decision making.

Download the conference brochure here.

Improving governance and accountability in children’s trusts

The Audit Commission has published Are we there yet? Improving governance and resource management in children’s trusts.

This report examined the progress local councils and their partners are making in developing children’s trusts. The report concludes that the ‘children’s trusts’ created by the government after the death of Victoria Climbie have been confused and confusing. Five years after the green paper Every Child Matters and eight years after the child’s death, ‘there is little evidence of better outcomes for children and young people’ resulting from the requirement that local areas in England set up arrangements to coordinate children’s services.

A third of directors of children’s services say that their partner organisations are ‘unclear’ of the purpose of children’s trusts, and the uncertainty is hampering their efforts to deliver better services. However the study did find that progress has been made in bringing professionals together, but sometimes by navigating around the ‘centrally-directed approach’. Local agreements worked better than external direction.

This report is all the more poignant given recent controversy surrounding the death of ‘Baby P.’ There is much in the report that can be used as learning that can be applied to the NHS.

For example, the Audit Commission has published a self assessment tool that children’s trust boards can use to assess their governance and accountability arrangements, as well as the way they manage resources. The key question areas in the self assessment tool for children’s trust boards to consider are:

1. How far does the children’s trust focus on improving outcomes for local children and young people?
2. How does the board oversee the effective use of resources?
3. What are the roles of the children’s trust partners in delivering improvement?
4. How does the board effectively consult, engage with, and involve key stakeholders?
5. How does the board support local capacity building and capability development?
6. How are good governance and the principles of public life demonstrated by the board?
7. How does the board manage risks and exercise proper controls?

Download the report and the self-assessment tool here.

FREE Governance between Organisations conference on 18 November 2008 – first come first served!

East Midlands Ambulance Service (EMAS), in association with Dynamic Change Ltd., is hosting a free conference on 18 November from 10.30-14.30 at the Gateway Hotel in Nottingham.

The conference features Dr John Bullivant and Professor Michael Deighan who have developed the Governance between Organisations concept and Toolkit.

Places will be allocated on a first come first served basis.

To book your free place e-mail Karen Kanee, Governance Manager, on karen.kanee@emas.nhs.uk or call 0115 9296151.

You can download a flyer for the event here.

For further information on Governance between Organisations, click here.

Governance between Organisations conference, 4 December 2008, Manchester

Healthcare Events is running a conference on Governance between Organisations at Machester Conference Centre on Thursday 4 December.

According to Healthcare Events, “The conference provides a practical guide to implementing Governance Between Organisations (GBO) across health and social boundaries including lessons from outside the NHS, the role of the effective board, partnership governance with the voluntary sector and the role of standards and performance montioring.You will also have the opportunity to attend the interactive conference workshop: Implementing the Governance Between Organisations (GBO) Toolkit in your organisation.”

For further information on the conference, download the brochure here.

For further information on Governance between Organisations, click here.

NHS publishes guidance on handover of patient care between ambulance and hospital

With the current interest in Governance between Organisations (e.g. click here), it is, perhaps, timely that NHS South West should publish detailed guidance for the NHS to assist in the timely handover of patient care from the ambulance to accident and emergency, or other hospital ward or department.

In his Foreword to the guidance, Sir Ian Carruthers, CEO of South West Strategic Health Authority, says that “Patient delays and ambulance handover waits have the potential to impact on patient care as well as wasting valuable NHS resources. Throughout the year, delays can be experienced by both patients and ambulance crews but historically, these delays increase during the winter months as pressure builds in acute settings.” He goes on to say that “it is vital that NHS organisations work together to develop systems and processes that manages patient care in an effective systematic way.”

Whilst there is no mention of Governance between Organisations in the document, the terms ‘appropriate governance’, ‘integrated governance’ and ‘clinical governance’ are (perhaps confusingly?) referred to.

All Acute Trusts and Ambulance Trusts as well as Primary Care Trust commissioners are invited to consider this guide and to decide locally, in light of it, if there are any steps they could take to help improve patient handovers.

Download the guidance, Ensuring timely handover of patient care – ambulance to hospital, here.

HSJ Event – Intelligent Information for Effective Governance, January 2009, London

The Health Service Journal (HSJ) has issued advanced notification that it is running the above event on 22nd January 2009 at Earls Court Conference Centre, London SW5. The sub-title for the event is Developing smart reporting systems to empower strategic decision making at Board level.

According to the HSJ, “Good governance is underpinned by intelligent information. Understanding what information is required to support strategic decision making at Board level is imperative. Especially following the launch of the new NHS performance framework, and with the emerging threat of the NHS failure regime.”

The HSJ says that “This unique and timely new national forum has been specifically designed for all senior managers with reporting responsibilities at Board level, IT specialists, and for NHS Board Members themselves. Book your place today to gain the tools and guidance you need to ensure accuracy, quality and relevance of information presented to NHS Boards.”

For full details of HSJ’s comprehensive programme click here.

The HSJ has announced that the following speakers have so far been confirmed:

- Joanna Davis, Chair, Birmingham Children’s Hospital NHS Foundation Trust

- Dr John Bullivant, Director, Good Governance Institute & Professor Michael Deighan, Specialist Advisor on Governance Between Organisations, Joint Authors of ‘Tensions and Issues in Governance’, Routledge 2009

- Stuart Emslie, Assistant Director, Centre for Corporate Governance and Ethics, Birkbeck London University and Visiting Fellow, Loughborough University Business School (and editor, Healthcare Governance Review)

- Rob Murray, Engagement Lead, Audit Commissions’ Trust Practice

A booking form for the event can be downloaded here and you and take advantage of HSJ’s early bird booking discount available until the 10th October 2008.

Health Care Risk Report Vol 14 Issue 9 September 2008

This issue of Health Care risk Report (HCRR), like so many others, has something for everyone.

The cause of healthcare governance is addressed in an article by Healthcare Governance Review editor Stuart Emslie. Essentially, Stuart reviews the new ‘governance between organisations’ debate paper and argues that it’s better management between organisations that is needed to improve services and reduce risks. Governance between organisations is, essentially, the “next taxi off the rank” in the wider world of ‘governance creep’.

There are three articles under the heading ‘risk management.’ The first explores how NHS trusts can use purchasing power to improve patient safety. The second argues that patients and trusts need a clearer view of the risks of infection. And the third provides guidance and advice to community nursing and other community staff on implementing the Mental Capacity Act and contains case examples.

Two legislation updates are provided. The first looks at the future of health care regulation in England, focusing on the role of the Care Quality Commission and the potential for confusion between the Commission and Monitor. The second provides an update on the Mental Health Act.

Finally there is the usual helping of helpful clinical negligence case reviews, plus an article looking at the health service ombudsman’s latest report on learning from complaints, which finds that poor communication is still a recurrent theme.

If you or your organisation do 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.

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.

May 2006 issue of Health Care Risk Report

This issue of Health Care Risk Report (HCRR) moves the journal on from being a professional journal, into the realm of incorporating peer reviewed articles. The single peer reviewed  in the current issue describes How NHS trusts could use patient safety indicators to help improve care and is written by Dr Alex Bottle and Dr Paul Aylin from the Dr Foster Unit at Imperial College Faculty of Medicine. Their research has found that US patient safety indicators, when applied to Hospital Episode Statistics data, will be of value in directing clinical audit towards important areas of potential harm, and helping trusts assess performance over time.

Other articles in the May issue of HCRR include:

- A review, by John Tingle, of the Healthcare Commission’s 2008 report Learning from investigations.

- An article titled Teams, staffing, training and governance: the recipe for safer births, by Sarah Davies and Dr Brenda Ashcroft of University of Salford, outlining the findings of Safe Births, Everybdy’s Business, the report of an independent inquiry into safety in maternity care

- Learning from homicides committed by mental health users. A review, by Pat Anderson, editor of HCRR, of NHS London work looking at 26 mental health homicides and also NPSA work relating to investigation of serious patient safety incidents in mental health services.

- An article, by Stuart Emslie, editor of Healthcare Governance Review, looking at extracting the learning from large patient safety databases.

- A review, also by Stuart Emslie, of the latest version of the Department of Health’s Integrated Governance Handbook, published by the Healthcare Financial Management Association; and

- A look at abortion law developments and professional bodies’ advice by Claire Bentley, solicitor and professional support lawyer.

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.

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.

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

Next Steps in Healthcare Governance – Master class and discussion workshop on ‘Governance between Organisations’

The Institute of Healthcare Management (IHM) has organised a special masterclass and discussion on ‘Governance between Organisations’ for the afternoon of 21 April 2008 in London. The event builds on the integrated governance work previously carried out by Dr John Bullivant and Professor Michael Deighan, authors of the Department of Health’s Integrated Governance Handbook. Participants to the event will have the opportunity to:

- Be briefed on this and up and coming governance development
- Input into the thinking and next steps
- Discuss appropriate local actions
- Consider the application of the governance healthcare standards and implications for healthcare commission declarations
- Find out about the pilot testing for governance between organisations
- Identify what steps local health and social care organisations need to take to develop governance during 2008/09

For further information, a flyer and application form, which must be returned to the IHM by 9 April 2008, can be downloaded at: www.ihm.org.uk/events/view/207