Fit for Purpose Governance in the NHS

A National Inquiry

“The effective spread of innovation is determined more by inter-personal and inter-organisational interaction than by structures and technology – like rugby, innovation spread is a contact sport.”Jonathan Lomas

Context• NHS Boards operate in a complex network

of local and national political relationships.• Boards make decisions on behalf of the

‘owners’. • A new contract is needed between people

and their services• WCC challenges Boards to find ways to

‘manage the system’ through governance.

It takes

• Legitimacy – making contested decisions

• Sustainability – how much assurance about what?

• Partnership – for the patient journey

• Multiple Perspectives – for adaptation (challenge for the sake of the task)

to govern NHS organisations

Confusion

• Between management and governance

• About the power of governance

• About the way of working assurance and innovation

• At executive level of the difference of working in the Board

• About accountability

And agreement about:

• The importance of the CEO Chair relationship

• The difficulty of governing a professional workforce

• The need for clear purpose

Our Questions

Effective in crisis

Focus on patients,

users, public

Engagementexternally

(Understanding the constraints) of professional/expert

model of organising

(Feeling powerful not) feeling powerless

Culture

DesignThoughtfully

designed

(Understand) why we are here

(Understand) who we are

Workingwith challenge

(Effective) relationship CEO – Chair

(Effective) induction and appointment

(Understand) what we expect of

each other

People

Work

Doing what?

Should be

Information

Balances limits of state and promoting the (local) organisation

Surfaces tension of focus on assurance v

focus development/progress

(Understand) tension management

v governance

Not just right people

Relating

‘What is’

Identity

Hypothesis

What’s getting in the way• Knowing how to govern for patient benefit• NHS antibodies to politics• The difficulty of securing challenge and making

the most of difference• Board processes for doing the business• Policy makers as observers not designers• How Boards view their role in reconciling the

designed in tensions in the NHS

What we need to do differently to achieve this

Design

Work

Culture

People

Work

• In what way do Boards deliver public value? What more can they do?

People

• What more can we do to develop the conditions for effective relationships in the Board

Culture

• How does the culture set or get set by your governance model?

Design

Design your ideal governance system for the NHS