NHS Governance – Creating a culture of improvement

 

About the Inquiry


Background

The Health and Sport Committee has agreed to conduct an inquiry into NHS Governance. The Committee is looking to explore the culture of the NHS and the way this impacts on patients. The Committee plans to look at a number of issues related to this theme including how change is managed in the NHS and the impact this has on staff.

The inquiry aims to ascertaining how well NHSScotland’s policies and systems are operating to deliver good governance and create a culture of improvement.

The Committee’s work will consider three main strands to NHS Governance. These are explained in some detail below:

1. Staff governance

This is the strand of governance that looks at whether staff are managed in a fair and effective way.

The NHS Reform (Scotland) Act 2004 gave NHS boards a duty over staff governance and the Staff Governance Standard for NHSScotland requires all boards to demonstrate that staff are:

  • well informed;
  • appropriately trained and developed;
  • involved in decisions;
  • treated fairly and consitently, with dignity and respect, in an environment where diversity is valued; and
  • provided with a continuously improving and safe working environment, promoting the health and wellbeing of staff, patients and the wider community.

Performance against the standard is monitored and the Scottish Government recently indicated that it plans to refresh its approach to monitoring (S5W-05767).

2. Clinical governance

This refers to the systems through which NHS organisations are accountable for continuously monitoring and improving the quality of their care and services, and ensuring they safeguard high standards.

NHS Boards are ultimately responsible for ensuring good clinical governance. However, the Quality Strategy sets out the national direction for improving the quality of healthcare.

The Scottish Government also published the Governance for Quality Healthcare Agreement in 2013 which sets out the respective roles and responsibilities of the Scottish Government, NHS board personnel and staff. It includes recommended actions in respect of risk management to support the oversight, planning, and delivery of healthcare services.

Healthcare Improvement Scotland also has a key role in supporting NHS Boards to develop and maintain effective clinical governance arrangements. It has also led the way in implementing some key national initiatives, for example, the Scottish Patient Safety Programme.

3. Corporate governance

Corporate governance generally refers to the structures and processes for decision making, accountability, control and behaviour at the upper levels of an organisation.

All NHS Boards should have a code of corporate governance in place and good governance is ensured through a Committee structure within each NHS board. Scottish Government Guidance for Board members outlines the role of the board as:

  • Giving leadership and strategic direction
  • Defining control mechanisms to safeguard public resources
  • Supervising the overall management of the body’s activities
  • Reporting on stewardship and performance

Approach

Given the broad nature of the topic, Members have agreed to undertake some preliminary investigations to explore particular areas of concern.

Informal evidence sessions

Members will undertake some informal evidence sessions with patient groups, frontline staff and senior managers, with a view to informing the inquiry further.

Phased approach

The Committee has agreed to break the inquiry down into different strands of governance:

  • Staff Governance
  • Clinical Governance
  • Corporate Governance

The Committee has agreed to consider staff governance first.

Following completion of this strand of work Members will consider its future approach to the clinical and corporate governance strands of its inquiry.

Timetable

Phase 1 - Staff Governance

Formal evidence sessions:  

The Committee held formal evidence sessions at its meetings on 30 May 2017, 13 June 201719 September and 26 September.   

Following the oral evidence session with the Cabinet Secretary on 26 September the Committee wrote a follow-up letter.

The Cabinet Secretary responded to the Convener's letter on 9 October 2017.

Informal evidence sessions:

The Committee has held three informal evidence sessions:

The first session was with NHS Scotland patients. Members reported back on their findings at the Committee meeting on the 21 March. 

The second session was with NHS frontline staff. Members reported back on their findings at the Committee meeting on the 28 March 2017.

The third session was with NHS senior managers. Members reported back on their findings at the Committee meeting on the 25 April 2017.

Phase 2 - Clinical Governance

Informal evidence session:

The Committee held an informal evidence session with NHS patients on 7 November.

Formal evidence sessions:

The Committee held formal evidence sessions on 14 November, 21 November, 28 November and 12 December.

Following the formal evidence session on 28 November, the Clerk to the Committee issued correspondence on 7 December seeking further information.

The Committee received the following letters in response on 18 December 2017:

On 24 January 2018 the Committee issued further correspondence to Professor Jason Leitch:

On 5 February 2018 the Committee received a response from Professor Jason Leitch:

Phase 3 - Corporate Governance

The Committee held formal evidence sessions on 20 February and 27 February 2018.

As part of the ongoing NHS Governance inquiry, the Committee issued a survey of all NHS board members in January 2018.  This covered a number of areas considered key to good governance.  The Committee received 126 responses.  This equates to 47% of all NHS board members in Scotland.

At the evidence session on 27 February, the Cabinet Secretary offered to write to the Committee with further information on prevention measures related to diabetes interventions and also examples of the impact of whistleblowers.  The Convener also requested the Cabinet Secretary's views on the impact on non-executive  members who are appointment to health boards but in receipt of welfare benefits.

At the evidence session on 27 February, the Cabinet Secretary referred to the forthcoming publication of the Staff Experience Report.  Following the publication, the Convener wrote to the Cabinet Secretary seeking clarification on the iMatter calculations. 

The Cabinet Secretary for Health and Sport responded on 24 April 2018:

NHS Tayside

We have received the following correspondence in relation to the Board of NHS Tayside:

Evidence

Phase 1 - Staff Governance

The Committee issued a call for written view which ran from 15 February until 15 March 2017.

Phase 2 - Clinical Governance

The Committee issued a call for written views which ran from 23 June until 9 August 2017.

Phase 3 - Corporate Governance

The Committee issued a call for written views which ran from 9 January until Wednesday 7 February 2018.

Report

Our Report "The Governance of the NHS in Scotland - ensuring delivery of the best healthcare for Scotland" was published on 2 July 2018 and can be accessed via our Committee Reports page.

On 3 September 2018 the Committee received a response to our Report from Jeane Freeman MSP, Cabinet Secretary for Health and Sport (note:  the Cabinet Secretary's letter refers to a letter received from COSLA, noted below):

On 2 October 2018 the Committee issued a response to the Cabinet Secretary's letter:

On 11 October 2018 the Committee received a response to their letter of 2 October from Jeane Freeman MSP, Cabinet Secretary for Health and Sport:

On 29 August 2018 the Committee received a response to our Report from Cllr Peter Johnston, COSLA Spokesperson, Health and Social Care:

On 2 October 2018 the Committee issued a response to Cllr Peter Johnston's letter:

 
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