NHS Governance – Creating a culture of improvement


About the Inquiry


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 devleoped;
  • 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


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.


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.

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:


Phase 1 - Staff Governance

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

Read the Call for Evidence

Read the Written Submissions

Phase 2 - Clinical Governance

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

Read the Call for Views

Read the Written Submissions

Phase 3 - Corporate Governance

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

Read the Call for Views