Leeds University publishes its NHS Governance Inquiry

The Centre for Innovation in Health Management (CIHM) at Leeds University has published its long awaited NHS National Governance Inquiry.

According to CIHM, “The NHS has an ‘addiction to crisis’ and runs most efficiently when under pressure responding to new policies, adverse incidents and deadlines………This means the NHS will either be well-placed to cope with the impending financial squeeze on public services due to the recession, or will struggle because the slow build-up to the expected cuts means it is unable to swing into action quickly enough.”

The team from the University of Leeds’ Centre for Innovation in Health Management (CIHM) looked at the state of NHS boards, how effective they are and how it might be improved.

The National Inquiry into Fit for Purpose Governance found a ‘culture of panics’ is endemic in the NHS, with short-term policy-making and performance management processes driven by external political influences. In addition, the NHS’ day-to-day core activity of trying to make sick people better through medical intervention can also be regarded as a form of providing a short-term response.

It found that non-executive board directors are unwilling to openly challenge their executive counterparts; that there is an excessive focus on the relationship between the chief executive and chairman to the detriment of other board members; and that there is too much emphasis on the structure of the board, rather than on its processes and dynamics.

The wide-ranging study also found that some boards cannot perform their jobs properly because members are not given enough or – in some cases – any reliable data with which they can question the decisions being taken.

Becky Malby, director of the CIHM and one of the report’s authors, said: “The NHS both hates short-term goals and performs best when dealing with crises. It is caught up in the need to ‘fix’ things and quite often these fixes fail. Dealing with longer term goals, or for that matter patients with longer-term conditions, is less ‘sexy’ and attracts less attention.

“Policy makers have learnt that in order to get the NHS to change, they need to create a short-term crisis. All our participants responded that they worked best when having to battle against the odds in the face of an external threat. This does not lead to NHS Trusts being able to perform well in the day-to-day business, nor to develop deeply-embedded quality services with adaptive capacity.

“The NHS will respond to the current economic crisis by taking short-term fixing measures. However this crisis needs a different response. It needs new ways of working, new partnerships with other agencies, and these take time to develop. There is time as NHS funding is secure for the next year, but in the face of that length of time to sort out what to do, the danger is that the NHS won’t know how to respond, as its traditional short-termism won’t work.”

The team from the CIHM interviewed 27 NHS board members and governance professionals from 13 NHS trusts across England as well as representatives from the Department of Health, strategic health authorities, commissions and independent consultants.

 The NHS’s predominant method of problem solving is also called into question, with the report saying that a reliance on an expert model, where problems are put into boxes and dealt with by the identified expert in that field, is not equipped to cope with today’s complex environment.

The report also found that the performance regime and focus on accountability were stifling innovation and had led to a box ticking culture where board members do not take responsibility for their actions.

The report concludes that boards of directors should continually try to remind themselves what the NHS is there for as they take contested decisions about the allocation of resources; and by being accountable for the performance of their organisations and the outcomes of service delivery.

Becky Malby said: “Even when put under considerable pressure, boards can and are capable of delivering. We are firmly convinced that there are enough individual skills and capabilities within the system to ensure its long-term success. It is therefore a matter of designing ways of working that use them appropriately.”

Download short and long versions of the inquiry report here.

Read a short Health Service Journal (HSJ) article by Becky Malby here.

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