Nine things NHS Boards should consider as trusts look at how to reset services

by Harriet Aldridge Director

Email +44 (0) 7841 568995

The NHS must take pride in the way it has responded to the pressure brought about by the global pandemic. This has dominated daily life in trusts for some months now. As the service considers how to manage the second phase of the response, NHS Boards have a critical role to play.

Boards must deliver the transition from crisis management to restart. They must capitalise on the lessons that can be learnt from the COVID-19 response, ensuring their organisations develop and implement future-proofed strategies that continue to respond to unpredictable pressures. At the same time, they must also manage new risks (e.g. the unprecedented backlog of elective care) and capitalise on new opportunities (e.g. the increased use of technology for remote consultations).

NHS Boards have a unique opportunity to use this moment to reevaluate their risk and assurance framework to ensure it is fit for purpose going forward. From our experience of working with a number of NHS boards, we believe there are nine actions that every board should consider over the coming months. These actions will strengthen their role and ensure they are supporting the overall strategy and good governance of their trust.

Taking stock

COVID-19 has rocked governance structures. How can your board get back in control, and what does the way your organisation responded tell you about the strength of your existing control and assurance framework?

  • Recognise your strengths and weaknesses - Your trust has been under the toughest of tests. Step back, take stock and recognise what the way the trust has responded tells you about the strengths and weaknesses of your assurance framework.
  • Revisit your risk appetite - Your board’s view of risk appetite will have changed, irrespective of whether or not this has been formally discussed. Identify where standards have been relaxed and attitudes have changed and formally work through the impact on the board’s approach.
  • Take the opportunity to really challenge existing understanding of trust culture - Faced with unprecedented pressure, the true nature of organisational culture becomes clear. Boards have a depth and breadth of evidence that has not been available before.

Being prepared 

How prepared are you to respond to forensic scrutiny of COVID-19 decision-making? Investigations and enquiries are already being commissioned and legal claims are being prepared.

  • Capture all data sources to Identify areas of material risk - Public inquiries will draw conclusions from all sources of evidence and you must do the same. Start with known sources (whistleblowing reports, staff and patient feedback), but be creative in challenging the extent of sources available.
  • Review key decision-making - Consider the evidence available demonstrating key decisions were made appropriately. If you identify gaps, work through what this means for the risks to which you may be exposed.
  • Prepare your staff for scrutiny - Your staff must be prepared to have their own actions and decisions scrutinised. How can you support them to be prepared for a difficult and unique experience.

Looking ahead

Does your strategy require evolution or revolution? What is the impact on recent and ongoing investment decisions?

  • Be ready to be agile - The context has changed, and new threats and opportunities exist. Is your board sufficiently agile to respond? For example, can you run rapid scenario testing to inform investment decisions?
  • Leverage healthcare technology - The pandemic has accelerated the adoption of technology (e.g. virtual appointments, online pharmacies). Do you know what this means for key estates, IT and other back office infrastructure decisions?
  • Review your system relationships - Reliance on system partners has been vital. What does this mean for the ambition of your system integration strategy?

Boards are leading NHS organisations in an enormously demanding environment and never more so than now. Trusts will need to continue to build resilience as we move through the response to the pandemic - strong boards are a vital component of overseeing and ensuring the delivery of strategic objectives and ensuring that the systems of control are robust and reliable and patients and staff will be the ultimate benefactors of a well governed trust

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by Harriet Aldridge Director

Email +44 (0) 7841 568995

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