Thome report on Mid Staffordshire looks to ensure governance and clarity of accountability

Dr David Colin Thome, National Director for Primary Care at Department of Health, has published his report on Mid Staffordshire NHS foundation trust alongside Professor Sir George Alberti’s report (click here).

Dr Thome makes recommendations in four key areas:

1. Involving patients and the public
2. Commissioning for outcomes supported by excellent use of appropriate data and information
3. Ensuring governance and clarity of accountability of all the different organisations in the system
4. Clinical leadership

It is refreshing to note that Dr Thome does not fall into the usual trap of confusing governance with management. There is no mention of boards managing the organisation and there is no reference to ‘Governance between organisations.’

His recommendation relating to ‘ensuring governance and clarity of accountability of all the different organisations in the system’ appear balanced and cover:

1. PCTs as local leaders of the NHS must assume ultimate responsibility for commissioning safe services and improving the health of their patients and populations.
2. All hospital providers including foundation trusts must allow PCTs ready access to review their services.
3. SHAs are the regional headquarters of the NHS, and in that role must ensure that the whole healthcare system discharges its responsibilities, with a particular emphasis on the performance management of PCTs to ensure that they are taking forward their leadership role. The Commissioning Assurance System for world class commissioning provides a framework for taking this forward.
4. PCTs and SHAs must be more proactive in informing Monitor of any concerns prior to foundation trust application and not assume that the regulators will take responsibility for ensuring quality of care. The regulators must share data and early concerns to allow PCTs and SHAs to take action.
5. The Department of Health should describe how the roles of PCTs, SHAs and the regulators are different and how they interrelate.
6. The Department of Health should set out clear expectations on all health organisations that effective ‘business continuity planning’ is the norm, and work in co-production with the NHS to develop guidance for organisational transition, including effective formal record keeping.
7. The NHS Confederation should consider how it can support PCTs through its network to develop their capacity and capability to respond to their role as local leaders of the NHS following lessons to be learnt from this review.

The Department of Health has published its response to the Alberti and Thome reports and this report, together with copies of the Alberti and Thome reports can be downloaded here.

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