World Class Commissioning Assurance Handbook – Year 2

The Department of Health has published its assurance handbook for year 2 of World Class Commissioning.

It is disappointing to note from the handbook contents that the Department of Health continues to fail to understand governance and the role and function of boards as governing bodies.

The handbook states that “The principle [sic]  functions of the PCT board are to set the strategic direction for the PCT and to exercise effective oversight and management. At all times the board members are accountable to the NHS and their local population for how they oversee investment and prioritisation and manage clinical, operational and service performance to drive better health outcomes, improve quality and reduce inequalities. The overriding objective of the board assessment is to understand the board and its sub-committees’ grip on the organisation, and their ownership and control of the commissioning agenda.”

In summary, the Department sees PCT boards as management boards – not governing boards, although they do talk of boards ‘oversight’ role.

Download the Year 2 World Class Commissioning handbook here.

The Intelligent Board 2009 – Commissioning to reduce inequalities

Three years ago The Intelligent Board series sought to create simple, practical guidance to help NHS boards use information intelligently to fulfil their roles. The Intelligent Commissioning Board was published just as the new boards for reconfigured PCTs were coming together for the first time. Since then, PCTs have matured as organisations and acquired increasing power and responsibility.

The Darzi report has refreshed the agenda for system reform and World Class Commissioning has set the pace. The introduction of Joint Strategic Needs Assessments and the new system of Comprehensive Area Assessments are raising the bar on partnership working to improve services and the wellbeing of local communities.

This latest report from Dr Foster aims to revisit the principles and approach first set out in The Intelligent Board and to apply them to the challenge of commissioning to tackle inequalities. The task Dr Foster set themselves was to plot a path through an area which is fraught with complexity and information overload and in which there are few unequivocal answers. According to Dr Foster, they ”have taken that complexity seriously but we make no apology for attempting to arrive at some simple, practical advice to help boards meet the challenge. We will have achieved our objective if this report prompts debate in PCT boardrooms and leads to action on using information intelligently to understand, tackle and monitor inequalities.”

Download The Intelligent Board 2009 – Commissioning to reduce inequalities here.

Governance arrangements to support PCT provider committees

The Department of Health (DH) and NHS Appointments Commission have issued guidance “ intended to help support PCT provider committees implement strong robust governance arrangements in order to deliver the transformation of community services.”

The guidance contains the following sections:

1 Good Governance for Community Services – This section sets out the scope of this guidance and provides the context for good governance within community services

2 Provider Committee -  This section sets out the key principles that should underpin recruitment of the independent members to Provider Committees, the advantages and disadvantages of the various recruitment options, the suggested appointments process and the roles and responsibilities of the independent members of the Provider Committee

3 Terms and Conditions for PCT Non-Executive Directors on Provider Committees – The terms and conditions for PCT non-executive directors serving as independent members of the Provider Committee are set out, including current arrangements for remuneration, time commitment, corporate responsibility and suspension and termination

4 Terms and Conditions for Independent Lay Members of Provider Committees - The terms and conditions for members of the Provider Committee appointed as independent lay members are set out, including arrangements for remuneration, time commitment, corporate responsibility and suspension and termination

5 Governance Good Practice – This section provides key principles and good practice around establishing robust governance arrangements for the operation of the Provider Committee, including terms of reference, delegation of powers, reporting arrangements, use of sub-committees and managing conflicts of interest

6 Resources – A list of relevant resources and guidance is provided

Download the guidance Transforming Community Services – Governance Arrangements to Support PCT Provider Committees together with a covering letter from David Nicholson, NHS chief executive, here.

Improving clinical governance in Out of Hours services – ECRI Institute’s INsight Systems Assessment

Out of Hours (OoH) services now provide patient care for 70 per cent of the patient week. With this comes the clinical governance challenge to ensure that the quality of service remains as high as ever, having reduced any exposure to unnecessary risks. Recent tragic events in the provision of Out of Hours services remind us that this is often a very difficult and ever present challenge for the commissioners and providers of these services.

This is why the ECRI Institute, a major non-profit health services research agency, and sponsor of Healthcare Governance Update, has developed its dedicated INsight ™ Systems Assessment Programme for the use of Out of Hours services. An INsight system assessment is a multidimensional organisation-wide patient safety, risk and quality systems assessment. It helps an organisation determine if its systems are robust, reliable and effective enough to support its governance responsibilities to ensure quality and meet the national standards.

More information about INsight System Assessment for Out of Hours Services is provided here.

ECRI Institute Alerts Tracker launched in primary care

ECRI Institute, a non-profit health services research agency and sponsor of Healthcare Governance Update, has recently launched in primary care its Alerts Tracker web based system for tracking action on safety alerts. Although the system has been widely used by secondary care providers in the UK and around the world for many years, it has recently been modified for use in primary care.

In launching Alerts Tracker for primary care, Dr David Watson, ECRI Institute Vice President UK & Europe, explained that primary care has just the same needs to ensure that the loop is closed effectively once a safety alert has been notified. Also, in ECRI’s experience it’s one thing to receive a safety alert but to get it into the right hands and get the necessary assurance that action had been taken was quite a different matter. He went on to say that many PCTs were seeing the advantage of the system as it reduced the need for lots of administrative time in chasing up action.

For further information click here –  Alerts_Tracker_HGR

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 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.

NPSA issues guidance to primary care teams on ‘Significant Event Audit’

The National Patient Safety Agency (NPSA) has issued guidance for primary care teams on Significant Event Audit (SEA).

SEA is defined as “A process in which individual episodes (when there has been a significant occurrence either beneficial or deleterious) are analysed in a systematic and detailed way to ascertain what can be learnt about the overall quality of care, and to indicate any changes that might lead to future improvements.”

SEA is, essentially, simply another term for ‘Root Cause Anlysis’. The use of the word audit is a misnomer since no audit activity takes place in an SEA – only investigation and analysis.

Notwithstanding these comments, Healthcare Governance Reviewbelieves that any attempt by the NPSA to help organisations and individuals improve the safety and quality of care is extremely welcome.

Download the guidance on Significant Event Audit here.