Blog: The surprising benefits to performance that mechanising assurance can bring

This blog reflects the discussion at GGI’s round table event, co-hosted with Allocate

Software, exploring the surprising benefits to performance that mechanising assurance cab

bring.

The Good Governance Institute (GGI) has been working in collaboration with Allocate
Software to explore how mechanised assurance can help to improve the performance of NHS
organisations, considering both the challenges the sector is facing and the ongoing movement
towards system working.

Following the development of a white paper, produced in collaboration with NHS colleagues, GGI and Allocate hosted a round table in London on 27 February 2018 to launch the first draft of the white paper and refine the recommendations contained within the white paper before its
publication. Discussion at the round table ranged from exploring and defining the value of
assurance, how effective assurance can support improvement in challenged trusts, and how to
ensure assurance is underpinned by engagement and a positive culture.

The session was attended by:
• Sam Armstrong, Board Secretary, Barking, Havering and Redbridge University Hospitals
NHS Trust
• Alex Bolton, Safety Learning Programme Manager, Chelsea and Westminster NHS
Foundation Trust
• Dr John Bullivant, Chair, GGI
• Andrew Corbett-Nolan, Chief Executive, GGI
• Angela Helleur, Improvement Director, NHS Improvement
• Karen Hunter, Non-Executive Director, Mid Essex Hospital NHS Trust
• Liz Jones, UK Marketing Director, Allocate Software
• Dr Nadeem Moghal, Medical Director, Barking Havering and Redbridge University Hospitals
NHS Trust
• Sarah Owers, Product Owner, Allocate Software
• Sara Turle, Member of the Patient Partnership Council, Barking, Havering and Redbridge
University Hospitals NHS Trust

Early on in the session, the point was made that there is currently a lack of centralised guidance on assurance, with the focus from the centre often being on compliance rather than assurance. There is room therefore for a more thorough and consistent approach from the centre, and a key focus of the round table was to consider what recommendations could be, for providers, regulators, GGI, and Allocate, as the NHS and assurance move forward.

Governance and assurance

The work and ideas of Professor Mervyn King, Chair of the South African Committee on Corporate Governance, were considered at the round table, with a particular focus on the use of governance as a tool to keep confidence in the system. It was also emphasised that there should be a strong connection within the NHS between quality assurance and the assurance of governance, however, it can often be difficult to describe the value of assurance. Assurance was described as a concept that when it is working well, you often do not notice it.

Nevertheless, it is something that in the complex environment the NHS is operating in today it is vital to get right, and the importance of successfully managing tensions between quality, cost efficiencies, and engagement in assurance was emphasised. Also discussed was the ethical and moral bottom line of governance, and that NHS board members are looking after something that is not theirs, and should aim to leave it in a better place than they found it. With this in mind, assurance should be ward to board and beyond, with the public looking to the board for assurance about the performance of their local health services.

Workforce and clinical engagement

Time was spent considering the importance of connecting assurance and workforce – ‘you uncouple the two at your peril’ – as the NHS is a human service. Policies and improvement strategies can live or die based on how far the workforce engages with them and proactively implements them, and it was suggested that the systems used can add value in terms of culture. It is key that any assurance system is reinforced and underpinned by a positive culture that supports staff to be innovative and focused on quality and performance improvement. In challenged trusts, it is also necessary to help staff gain confidence about the issues the organisation is facing. Good governance should be found not just at board level but at department and divisional level, as well as non-clinical areas.