Update on NHS Governance Guidance – Guidance on good governance and collaboration

NHS England has published new guidance on good governance and collaboration that sets out NHS England’s expectations on how NHS provider trusts should collaborate and the key governance characteristics that trusts must have in place to support this. The Guidance links effective collaboration to the governance licence condition under the provider licence.

The Guidance applies to NHS trusts, foundation trusts and NHS-controlled providers. Further the Guidance may also be relevant to some independent providers providing commissioner requested services and systemically important services at scale.

The Guidance acknowledges that the Health and Care Act 2022 aimed to remove legal barriers to collaboration and integrated care to enable providers to use knowledge and experience to take on greater responsibility for service planning and putting integrated care systems on a statutory footing.

Effective collaboration requires system-minded leadership, which must be underpinned by organisational and individual behaviours that create the right environment for collaborative change. Providers can put in place governance arrangements to help ensure that these essential ingredients are in place and are used to deliver system improvements.

The Guidance aims to set clear expectations on how providers should work and collaborate with partners via system and place-based partnerships, and provider collaboratives, and the governance arrangements that must be in place to support this, to comply with the governance conditions of the NHS provider licence.

The Guidance makes clear that the success of individual NHS trusts and foundation trusts will increasingly be judged against their contribution to the objectives of the Integrated Care System (ICS).

The four aims of ICSs are:

• improve outcomes in population health and healthcare;
• tackle inequalities in outcomes, experience and access;
• enhance productivity and value for money; and
• help the NHS support broader social and economic development.

The Guidance further provides expectations on providers in terms of collaboration in the following three key areas:

• engagement in shared planning and decision-making;
• collective responsibility with partners for the delivery of services across various footprints including system and place; and
• taking responsibility for delivery improvements and decisions agreed through system and place-based partnerships, provider collaboratives and other forums

as well as detailing example (non exhaustive) illustrative minimum behaviours linked to these key areas.

The Guidance provides details about the characteristics of governance arrangements to support effective collaboration, including the (non-exhaustive) key lines of enquiry for providers to consider with respect to each of the five characteristics of governance arrangements detailed in the guidance. It is to be noted that the key lines of enquiry provided in the guidance are not intended to be used as a compliance checklist. However, the new guidance provides a useful framework for providers to consider in addition to other guidance on good governance and statutory obligations, such as the duty of NHS bodies to cooperate with each other in exercising their functions, in accordance with the NHS Act 2006 (as amended).

Integration and collaboration have long been recognised as key to strengthening and developing NHS organisations. This new guidance on governance and collaboration recognises the importance of governance to the widely hailed aims of collaboration. Time will tell whether the changes brought in by the Health and Care Act 2022 can truly equip providers with the tools for effective integration and collaboration.

NHS England anticipates that this Guidance on good governance and collaboration shall contribute to how NHS England oversees providers’ collaboration under the NHS Oversight Framework. Following the implementation of informal and formal dispute resolution processes, NHS England where appropriate may intervene to resolve situations where poor governance means that a provider appears to be failing to collaborate in line with the guidance or governance obligations in the NHS provider licence. NHS England will consider if formal regulatory action must take place, drawing on this new guidance on a case-by-case basis.

The new guidance also draws out example scenarios illustrating ways in which providers can collaborate effectively in its appendix.

The new guidance can be found here.

HOW WE CAN HELP

Our team of regulatory and commercial experts regularly advise clients on governance and collaboration matters for NHS commissioners and providers. Should you wish to discuss any issues relating to NHS governance, of how we can support you on your collaboration and integration journey then please contact Vincent Buscemi or Louise Brennan.