Fit for Purpose Governance in the NHS A National Inquiry “The effective spread of innovation is determined more by inter-personal and inter-organisational interaction than by structures and technology – like rugby, innovation spread is a contact sport.” Jonathan Lomas

Context NHS Boards operate in a complex network of local and national political relationships. Boards make decisions on behalf of the ‘owners’. A new contract is needed between people and their services WCC challenges Boards to find ways to ‘manage the system’ through governance.

It takes Legitimacy – making contested decisions Sustainability – how much assurance about what? Partnership – for the patient journey Multiple Perspectives – for adaptation (challenge for the sake of the task) to govern NHS organisations

Confusion Between management and governance About the power of governance About the way of working assurance and innovation At executive level of the difference of working in the Board About accountability

And agreement about: The importance of the CEO Chair relationship The difficulty of governing a professional workforce The need for clear purpose

Our Questions Effective in crisis Focus on patients, users, public Engagement externally (Understanding the constraints) of professional/expert model of organising (Feeling powerful not) feeling powerless Culture Design Thoughtfully designed (Understand) why we are here (Understand) who we are Working with challenge (Effective) relationship CEO – Chair (Effective) induction and appointment (Understand) what we expect of each other People Work Doing what? Should be Information Balances limits of state and promoting the (local) organisation Surfaces tension of focus on assurance v focus development/ progress (Understand) tension management v governance Not just right people Relating ‘What is’ Identity

Hypothesis What’s getting in the way Knowing how to govern for patient benefit NHS antibodies to politics The difficulty of securing challenge and making the most of difference Board processes for doing the business Policy makers as observers not designers How Boards view their role in reconciling the designed in tensions in the NHS

What we need to do differently to achieve this Design Work Culture People

Work In what way do Boards deliver public value? What more can they do?

People What more can we do to develop the conditions for effective relationships in the Board

Culture How does the culture set or get set by your governance model?

Design Design your ideal governance system for the NHS