In January 2014, Monitor (the sector regulator for health services in England) published draft guidance for NHS foundation trusts to structure reviews of their governance.

The proposed framework expands on the existing quality governance approach to include the board’s role in strategic planning and organisational oversight. It sets out four domains, several high level questions and a body of ‘good practice’ that reviewers and organisations can use to assess governance.

The Health Foundation’s response

In our response we:

  • set out our evidence about the role of boards in promoting quality improvement, patient safety and person-centredness
  • make specific recommendations on the governance review process and make recommendations about the domain of measurement, specifically how patient safety and person-centred care can be measured by boards.

We agree that there needs to be a robust system for reviewing board governance – given the significant role boards play in driving and embedding improvement in care. We think that board members and other staff need to be closely involved in the review process and that this will help to build capability, ensure that findings are meaningful to the organisation and have a resonance beyond the lifetime of the review.

We also suggest that the review needs to pay close attention to how data and other intelligence about safety and quality is interrogated and used by boards. It is crucial to ensure that boards have the skills necessary to interpret data effectively and appreciate its limitations and are not reliant on written intelligence alone.

Finally, we think the way person-centred care is defined needs revisiting. The review process provides an important opportunity to assess to person-centredness of the care being delivered by each organisation, so we need to ensure that the associated review guidance provides a clear explanation of the areas on which boards need to focus.