Striking The Balance

Author:ICSA &nbsp

The recommendations from the latest UK Corporate Governance Code and FRC Guidance pose some interesting challenges for governance within the developing NHS landscape

Students undertaking The Chartered Governance Institute's Health Service Governance module find themselves having to sit with one foot firmly in the world of corporate governance and the other firmly in the world of health service governance. This unique combination helps to support those qualifying as governance practitioners to be able to understand the role of governance from a wider perspective. Despite the fact that the UK Corporate Governance Code and its associated guidance is not directly applicable in the health service sector, it is, nevertheless, interesting to see how corporate governance codes can illustrate aspects of best practice and lead to some interesting challenges or areas of development for governance within the NHS.

A current example of this is the emphasis in the latest UK Corporate Governance Code (July 2018) on the increasingly important role of the board in assessing and monitoring culture. The associated guidance of the FRC Code on Board Effectiveness went even further by saying "Boards need to think deeply about the way in which they carry out their role. The behaviours that they display, individually as directors and collectively as the board, set the tone from the top".

If this is taken as the current zeitgeist of our times as we reflect back on the failures of corporate governance which were highlighted by the banking crisis, then it is interesting to see how this might be reflected in the actions and behaviours of those charged with governance within the NHS; from the board of NHS England/NHS Improvement through to the programme board of a workstream within a local Sustainability and Transformation Partnership (STP) or Integrated Care Systems (ICS).

Culture and Transformation

NHS Improvement (Valued care in mental health: a national improvement model, Oct 2018) defines culture as: "the rich pattern of social behaviour present in an organisation over time, including all spoken and unspoken rules, symbols, routines and stories. Culture binds together an organisation's different parts, giving identity to the whole".

The challenge for the NHS is how to bind all parts of it together to focus on the safety, recovery and wellbeing of those who use the NHS and those who work there.

The UK Code is written with companies and their boards in clear view...

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