A blueprint for the controlling mind of the NHS

John Brown discusses leadership, management and governance in the NHS ahead of the RCPE Governance Conference

Thursday 9th May 2019

Ahead of tomorrow’s inaugural RCPE Quality Governance Conference, we spoke to John Brown CBE, chair of NHS Greater Glasgow & Clyde, interim chair of NHS Tayside and the author of a new framework for governance in NHSScotland.

h&c.s: As author of the Blueprint for Good Governance that was sent out to all NHS Boards earlier this year, can you tell us about the framework and where it sits in the wider range of work going on in Scotland’s health service to develop governance?

John Brown: Every organisation in the public sector, the NHS included, has clear challenges that they are trying to cope with: increased demand for services at a time when there are finite resources, at the same time as trying to capitalise on advances in science and technology.

They are also trying to respond to increased customer expectations – patients’ expectations of the health service have changed over the years so the people in charge are trying to get the design of the organisation and the business models right to deliver accessible, safe and patient-centred quality health and social care.

To do all of that we need to develop the capability and capacity of the organisation and the people within it. When making decisions about how services should be delivered, I would suggest there are three aspects to what I refer to as the controlling mind of an organisation: corporate governance, collective leadership, and operations management.

Within the NHS we are looking at all three aspects of that in parallel to try and improve the overall capability and capacity of the organisation to meet ongoing challenges.

Susan Walsh – who was at that time a board member of Healthcare Improvement Scotland - and I were asked some time ago to look at in particular corporate governance within NHSScotland.

We came up with the notion of creating a blueprint for good governance to help us do three things.

Primarily to gain a greater understanding of what corporate governance is and where it fits with leadership and management in the NHS, and also to give a structured approach to assessing our current governance systems against a best practice model, which would in turn help us develop a programme to improve corporate governance.

At the same time as this research to develop the model we undertook reviews of governance in NHS Highland and NHS Tayside and that provided a testing ground for a model to be developed, which led to the production of an assessment tool for NHS boards in the form of the blueprint.


h&c.s: What are the next steps to turn the blueprint into reality for Scotland’s boards and partnerships?

John Brown: We have set up an NHS Scotland corporate governance steering group that I co-chair and we have a programme to implement the blueprint.

All 22 boards received the blueprint and took a survey related to it. They then had an event to discuss the survey results, looking at how well we were delivering on the five functions of good governance: setting direction; holding to account; engaging stakeholders; influencing culture; and assessing with risk.

They looked at how boards were delivering these functions and how this was influenced by the flow of information to boards, their audit and administration processes. From that each board then produced an action plan which was submitted to the Scottish Government.

These action plans are currently under consideration by the corporate governance steering group which is summarising the plans, looking for key themes – whether that be issues that need tackled at a national level and delivered once for Scotland, or issues that are individual to particular boards and where they are in their development.

This baseline assessment will inform the implementation programme which is already in place to assess what we are already doing and highlighting where we need to act to improve governance.

It’s all about identifying best practice with a view to standardising and implementing that best practice across Scotland, taking into account the individual nature of each board.


h&c.s: What plans are in place to use the framework and the results of the self-assessment tool to drive forward improvements in governance?

John Brown: One of the key components we are also looking at is also how governance is assured. We intend to continue with the annual self-assessments that boards undertake, but we are also introducing an external assurance of the boards so that we don’t fall into the trap of boards thinking they’re doing okay when they’re not.

We have options for this process that would centre on looking at the blueprint, assessing the boards against this then comparing that with the boards’ own assessments of how they are doing.

We have been looking at external providers coming in whether that be a larger auditor or a smaller firm specialising in governance, or indeed someone like the Royal College of Physicians of Edinburgh who are doing a lot of work in this space.

We could look at peer-reviewed methods, where one board could review another, or look at peer-review within Scottish Government departments.

Audit Scotland could also be asked, or a group set up within the Scottish Government itself. We’re in the midst of an options appraisal which will be taken to the steering group and then submitted to Government to see how we progress here.

This will also give us the capability to look at a particular aspect of governance across Scotland as we will have a ready-made source of information.

If we want to look at, for example, stakeholder engagement, we could do an external review of this again by looking at the boards’ own assessments, looking at their own improvement plans and coming to a view as to whether they are sufficient to meet the challenge identified.


John Brown will be facilitating a workshop on the blueprint for good governance at the Royal College of Physicians of Edinburgh’s Quality Governance Conference tomorrow.

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