King V: bridging excellence

Prof. Andrew Corbett-Nolan looks at leveraging the new framework for NHS and other health boards

In the dynamic realm of UK healthcare and social care, regulatory evolution demands more than adaptation—it requires reinvention. The Care Quality Commission (CQC)'s single assessment framework, with its sharpened focus on the ‘well-led’ domain, underscores this imperative.

For public-purpose organisations, from NHS trusts and integrated care boards to independent care providers and hospices, achieving excellence means embedding leadership that is not only compliant but visionary, inclusive, and resilient. This framework evaluates whether organisations possess the capacity to deliver high-quality, person-centred care that is safe, sustainable and equitable, actively tackling health inequalities in an era of fiscal pressures and post-pandemic recovery.

At the heart of this reinvention lies a hierarchy of governance wisdom, where the various reports from South Africa's King Committee emerge not as one voice among equals, but as the original blueprint—the comprehensive, evidence-based architecture for steering organisations toward sustainable success.

Their latest report, the just-published King V, transcends structure and process, infusing governance with purpose, dynamism, and the profound human element of the board as a collective moral compass. In contrast, the NHS code of governance for provider trusts, while invaluable as a structural anchor tailored to the UK's public sector, remains more prescriptive and procedural, focusing on mandatory mechanisms without fully illuminating the transformative impact or ethical depth that King V so elegantly captures.

The CQC's well-led framework, for its part, serves primarily as a regulator's lens for assessing organisational ‘fitness to trade’—a vital checkpoint, yet one designed for evaluation rather than inspiration, lacking the rigorous, outcomes-driven research that underpins King V's principles.

Guiding authority

GGi would position King V as the guiding authority. It provides the means whereby the best boards can elevate and integrate the NHS Code's rigour and the CQC's assessment criteria into a cohesive strategy. Through a three-way comparative analysis—juxtaposing well-led expectations with King V's foundational principles and the NHS code's standards—we reveal actionable pathways where King V provides a compelling means towards excellence: not just aligning compliance, but inspiring ethical excellence and measurable impact.

A diagnostic chart maps these synergies, followed by a granular deep dive into the ‘governance and management’ pillar, where King V's dynamic oversight transforms structural tools into living systems of assurance. By centring on King V, leaders can convert regulatory demands into opportunities for profound organisational flourishing.

Demystifying the CQC's well-led domain

The CQC's well-led key question is deceptively simple: does the organisation have the leadership capacity and capability to deliver high-quality, compassionate care? Yet, its scope is expansive, integrating four pillars that form a holistic assessment lens.

Launched as part of the 2023 single assessment framework, well-led ratings influence overall organisational scores, with ‘outstanding’ reserved for those demonstrating transformative leadership that drives systemic improvements.

• Leadership: This pillar probes the executive team's ability to inspire and empower staff, forging partnerships across sectors to ensure care is integrated and equitable. Evidence includes leadership development programmes, diversity metrics, and collaborative initiatives that demonstrably reduce disparities—such as targeted outreach in underserved communities.
• Vision and strategy: Organisations must articulate a forward-looking direction attuned to user needs, regulatory shifts, and broader societal goals like net-zero ambitions. Assessments review strategic plans, horizon-scanning exercises, and adaptive responses to feedback loops, ensuring strategies evolve with evidence.
• Culture: Here, the CQC seeks a palpable ethos of openness, respect, and continuous learning. Metrics encompass staff engagement surveys (e.g., via the annual NHS staff survey), freedom-to-speak-up guardians, and incident reporting trends, revealing whether psychological safety underpins daily operations.
• Governance and management: The bedrock of assurance, this evaluates systems for oversight, risk mitigation, and performance scrutiny. Boards must show how they monitor key indicators, delegate effectively through committees, and use data for proactive enhancements, all while maintaining transparency with regulators and stakeholders.

These pillars are interlinked; a weakness in governance can cascade into cultural erosion or strategic misalignment. With inspections increasingly data-driven—drawing from real-time submissions and triangulated sources—organisations must prepare robust, auditable narratives. Yet, as an assessment tool, well-led excels at flagging deficiencies but stops short of prescribing the inspirational governance that fosters true excellence—a gap King V is uniquely positioned to fill.

King V: the original blueprint for ethical and dynamic governance

King V elevates governance beyond compliance to a moral and strategic imperative: "the exercise of ethical and effective leadership by the governing body to enhance and protect value creation over time."

Unlike the more static mandates of frameworks like the NHS Code, King V is a living blueprint, grounded in decades of empirical research that links its principles to tangible organisational outcomes—such as improved resilience, stakeholder trust, and long-term value creation. Its foundational concepts pivot on four meaningful outcomes:

• Ethical culture – the shared values, beliefs and practices within the organisation that promote ethical behaviour and decision-making.
• Performance and value creation – organisational performance that creates value in a sustainable manner within the organisation’s economic, social and environmental context.
• Conformance and prudent control – adherence by the organisation to the spirit and intent of laws and policies, non-binding rules, codes and standards as adopted by the organisation, as well as the establishment of an effective system of internal controls and accountability mechanisms.
• Legitimacy – the social licence to operate that the organisation has acquired, in addition to its formal legal right or license to operate, through transparently demonstrating its trustworthiness and responsible corporate citizenship.

The meaningful outcomes are underpinned by 13 principles spanning leadership, strategy, reporting, and stakeholder relations.

What makes King V the most useful starting point for boards is its holistic embrace of governance as a dynamic, human endeavour. Central to this is the six capitals model (financial, manufactured, intellectual, human, social/relationship, and natural), which encourages integrated thinking: a holistic appraisal of interdependencies to balance short-term gains with long-term sustainability.

The Ubuntu-Botho philosophy infuses this with relational depth, urging boards to function not as isolated executives but as a cohesive team of humans—bound by shared values, compassion, and accountability—serving as the organisation's ethical and moral compass. This human-centric lens addresses the purpose and impact of governance head-on: how does the board steer not just compliance, but collective flourishing?

Implementation is flexible yet rigorous via an ‘apply-and-explain’ regime, where organisations disclose how principles are adapted to context, promoting proportionality for entities of varying scale. Recommended practices include regular governance effectiveness reviews, integrated reporting aligned with the International Integrated Reporting Framework, and stakeholder mapping to ensure inclusivity.

Research evidence underscores King V's evidence base: adopters report higher foresight in risk management and enhanced board cohesion, outcomes that structural codes alone cannot replicate. For public purpose bodies in the UK, King V's emphasis on legitimacy—through transparent accountability and ethical citizenship—resonates deeply, offering a researched pathway to navigate scrutiny while amplifying mission impact. It inspires excellence where others just mandate it.

Ubuntu-Botho philosophy

The represents a cornerstone of Southern African humanism, rooted in Bantu value systems that prioritise communal harmony over individualism. Derived from Nguni (Ubuntu) and Sotho/Tswana (Botho) languages, it embodies the maxim ‘umuntu ngumuntu ngabantu’ (I am because we are) emphasising that personal fulfilment emerges from interconnected relationships.

At its core, Ubuntu-Botho fosters qualities such as compassion, generosity, hospitality, and mutual respect, viewing humanity as a collective endeavour where one's wellbeing is tied to the community's. It critiques colonial individualism, advocating instead for ethical living through sharing resources, resolving conflicts via dialogue, and nurturing social bonds. In practice, this manifests in rituals of ubuntu, such as communal mourning or village decision-making, where exclusion diminishes one's own humanity.

Today, Ubuntu-Botho influences global ethics, education, and leadership, inspiring movements for restorative justice and inclusive policies. By rejecting isolation, it reminds us that true excellence lies in uplifting others, cultivating a world of shared dignity and resilience.

The Code of governance for NHS provider trusts: a structural foundation to be elevated by King V

Tailored for NHS provider trusts, the 2023 NHS code of governance sets mandatory standards for board composition, conduct, and oversight, reflecting the sector's dual accountability to patients and the state. Overseen by NHS England, it comprises seven principles: values and culture, effective board, strategy and planning, financial and performance management, risk management, information governance, and working with partners.

The code mandates a majority-independent board with diverse skills, annual effectiveness evaluations, and clear separation of executive and non-executive roles. It stresses ‘fit and proper person’ requirements, conflict-of-interest protocols, and integrated risk registers that align with national priorities like the NHS long term plan. Reporting obligations include annual governance statements in quality accounts, audited against the code to assure parliament via the Department of Health and Social Care.

While the NHS code provides a sturdy structural scaffold—essential for operational consistency in a publicly funded system—it lacks the depth to explore governance's broader purpose, dynamic evolution, or the board's role as a human team embodying ethical stewardship. Its binding nature ensures baseline compliance, with non-compliance risking regulatory intervention, yet it functions more as a checklist than a catalyst for impact.

This is where King V usefully illuminates a path forward: by overlaying King V’s good governance principles, the NHS code's mechanisms gain vitality, transforming rigid structures into adaptive systems that deliver researched outcomes like enhanced legitimacy and value creation. For UK healthcare providers, this integration means using the code as a foundation upon which King V builds inspirational, outcome-orientated governance.

Synergies through a King V lens: aligning frameworks for inspired compliance

Boards should most usefully use King V as their starting point. Viewing the well-led framework, the NHS code and King V through a hierarchical prism—with King V as the apex—reveals profound synergies, where the former two become enhanced instruments within King V's blueprint.

The chart below maps these alignments, emphasising how King V's principles provide the overarching guidance, infusing purpose and dynamism into the CQC's assessment criteria and the NHS code's structures. This is not an equal-footed comparison but a strategic elevation: King V steers the integration, ensuring governance serves as an ethical compass that inspires excellence beyond mere fitness to trade.

This mapping underscores King V's role as the unifying force: it provides the evidence-based blueprint that animates the NHS code's foundations and satisfies the well-led framework's evaluations, creating governance that is not just compliant, but transformative.

Granular deep-dive: governance and management – King V as the dynamic ethical engine

Among well-led pillars, ‘governance and management’ stands as the operational engine, demanding systems that not only detect but anticipate risks, optimise resources, and propel outcomes. For public purpose organisations, where stakes involve lives and public funds, this pillar's granularity can make or break ratings. It recognises that good governance is not a morally neutral act. Through a King V lens, it becomes more than a regulatory checkpoint. It evolves into a dynamic expression of the board's collective conscience, where human teamwork drives ethical control and prudent stewardship. The NHS code offers structural bolsters, and well-led provides the assessment yardstick, but King V's researched principles ensure these elements cohere into a blueprint for sustained (indeed inevitable) excellence.

To unpack this hierarchy in action, the table below dissects key sub-elements of governance and management. It positions King V's concepts as the guiding blueprint, with rows illuminating how its dynamic, purpose-driven tools elevate the NHS code's mandates and meet well-led's evidence demands. This granular view highlights the rationale for that first focus being on King V's very practical prescription for success: its emphasis on the board as a human team fosters moral agility, backed by empirical evidence of impact, far beyond structural prescriptions.

Why this King V-centric triad matters for UK public purpose organisations

In a landscape scarred by multiple inquiries where governance lapses amplified harms, the urgency for a practical and engaging blueprint like King V is undeniable. It does not just align the Well-led framework and NHS code but provides the board with a compelling focus, countering fragmentation with holistic, human-centred resilience.

For non-NHS entities (e.g., hospices), adopting King V signals ethical maturity, easing CQC dialogues while embedding researched impact. Amid 2025's fiscal squeeze—NHS deficits hit £2.3bn—this triad, led by King V, optimises stewardship: its dynamic principles future-proof missions by weaving purpose into every decision, from ethical risk-taking to stakeholder flourishing. Organisations embracing this hierarchy will achieve not just compliance but cultural vitality, with their boards evolving as true moral teams, driving outcomes that regulators reward and communities cherish.

A board focus on good governance leading to regulatory compliance as the inevitable byproduct

As CQC inspections intensify, centring on King V with its ethical blueprint and evidenced dynamism positions the board to deliver Well-led and the NHS code. As we have explained this is not just a neat alignment but reimagining governance as the board's collective conscience, steering public purpose toward compassionate, impactful stewardship. Far beyond assessing fitness or enforcing structures, King V inspires the human teamwork that defines success.

As Dame Julia Unwin so adeptly put it, “I have seen boards that are entirely entrepreneurial, and they are pretty scary. I have also seen boards that are entirely compliance driven, and they are truly terrifying.”