Governance in HPSS

“…… an important pillar in building public and political credibility for our Service, is the continuing development of effective governance arrangements. Not only must we exercise proper accountability for the funds we use, but we must also ensure that we exercise proper care and provide protection for staff and service users in all that we do.

It is understandable and utterly right and proper that our services and their impact on people’s lives should be the focus of public, political and media scrutiny. We have control of a very substantial amount of public money and we are charged with supporting some of the most vulnerable people in our society. Moreover, the nature and extent of our services are such that we touch the lives of everybody in some way or another. This means that beyond our duty to account to Parliament and to the taxpayer for the proper use of money, we also have an equally important duty to protect users, carers, staff and others in the planning and delivery of our services. This means that our governance arrangements must span all aspects of our business, whether:

Common to all of these strands of governance is the need for a sound system of risk management underpinning all of the arrangements we put in place. Risk management is not a new concept for us. Formally or informally, it is already part and parcel of management arrangements at many levels within HPSS bodies. Nevertheless, in recognising that much good work has been done, the recent NIAO Report and subsequent PAC hearing on Clinical Negligence Claims did highlight the need for common progress to be made, both within organisations and across the HPSS as a whole.

In responding to these points, we were able to point to our decision earlier in the year to adopt a common, internationally recognised model of risk management for the Department and all HPSS bodies. The work of putting the fundamental building blocks in place to support the Australia/New Zealand model of risk management is already underway and it will be important to demonstrate that real progress has been made by the end of this financial year. From next April, we will need to be able to demonstrate that the practical business of identifying, evaluating, treating, reviewing and reporting risk across each organisation is underway.

In addition to the organisation-wide system of risk management, the Department has begun to develop standards that will focus on key areas of risk within the HPSS and provide a vehicle for Accountable Officers to report the extent to which risk is being effectively controlled. We are unashamedly using the good work that has already been done by the Controls Assurance Project in the NHS in England but the plain fact is that we do not have the same level of resources available to us and our approach will have to be tailored to suit circumstances here.

Initially, the standards will cover areas of financial and organisational governance but it is envisaged that, as the clinical and social care governance agenda develops, there will eventually be a range of standards covering all aspects of governance in the HPSS. HPSS bodies have nothing to fear from this approach. This is about consolidating existing standards, identifying and applying best practice and offering assurance that we are doing our reasonable best to control the risks to the achievement of our objectives. In this way, we will ensure that resources are maximised for frontline services; that we provide a safe environment for care; and that the quality of care meets acceptable standards.

Compliance with standards, however, will not in itself provide all the necessary assurance about internal controls. The key to this is the organisation-wide system of risk management, fully embedded in the management activities of the body.

And that brings me to another element of governance – quality. As I mentioned earlier, we will be able to put in place the legislative aspects of the quality approach set out in Best Practice, Best Care through the Order in Council procedure at Westminster. With the agreement of our Minister, we will also progress those aspects of the proposals that do not require legislation.

The Department has already issued a draft circular to all HPSS organisations outlining guidelines for implementation of Clinical and Social Care governance and it is intended that a final guidance circular will issue shortly. As part of the process of developing and implementing these arrangements, we are asking all organisations to ensure that a senior professional at Board Level is identified to provide leadership for these arrangements and I hope that this will be taken seriously to ensure that there is the proper impetus to drive this forward.

I want us to be in a position where all of our organisations take corporate responsibility for the quality of their performance and the provision of the highest possible standards of clinical and social care. To achieve this, we need to build a framework which will bring together activity on a number of critical elements, including audit; identifying and sharing good practice; risk assessment and risk management; quality standards; complaints management; and clinical and social care effectiveness. This will ensure that the risks are minimised, that high quality, effective care is delivered and that where things do go wrong, they are quickly put right and lessons are learnt to help prevent its recurrence.

The detailed requirements arising from clinical and social care governance will be developed in the form of guidance and guidelines. This will involve significant engagement and consultation with the Service, beginning with a series of workshops to be held across the four Board areas in January and February next year to discuss the way forward. I hope that there will be a high level of engagement in this process.”