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The integration of services requires multiple organisations to work closely together. This can be a challenge where organisations operate under different regulatory, statutory and financial regimes and where staff may have an understandable desire to maintain the integrity and success of their own organisations.
The successful implementation of new care models for integrated services will depend on organisations overcoming these challenges. Robust governance will be essential to this on a number of different levels:
Boards, CCG Governing Bodies, and other governance groups such as Foundation Trust Councils of Governors, CCG members’ committees and Health and Wellbeing Boards will play a crucial role in assuring the rationale for change, setting the vision and values, determining scale of ambition and appetite for risk. As a new care model is implemented they will also be responsible for maintaining good corporate governance for their organisation. This will include complying with the regulatory requirements of NHS Improvement and the Care Quality Commission and complying with fundamental standards of care and the well-led framework.
Whilst retaining responsibility for corporate governance for their own organisation, leaders also need to consider the governance implications of collaborating with other organisations. In some cases – for example where a new care model involves transfers of services between different organisations – system redesign may not significantly affect existing governance structures. But in others – for example where a new ‘integrated care organisation’ is set up – it will be vital to ensure that governance for the new structure is robust. This will be particularly important where new boards are set up with a leadership role for making decisions about changes.
Whether the new care model involves collaboration through loose structures for joint working or new boards with the authority to make decisions on behalf of multiple parties, governance structures must be clear, documented and effective.
Empowerment and engagement
Organisations need to find ways to engage with and empower staff, patients and other stakeholders so that proposals for new care models are genuinely responsive to local needs. This is partly about leadership, partly about ownership and partly about compliance with legal duties to consult (see our previous section about this).
Getting the governance right – key questions
- What will be the role of existing Boards and other governance groups in developing and implementing new care models?
- Should a Strategic Partnership Board be established to make decisions about new care models?
- How can staff, patients and other stakeholders, including from the voluntary and third sectors, be engaged in decision-making about new care models?
- If there is a Strategic Partnership Board what will its role be in overseeing delivery of services in the new care model?
- Taking these questions into account, how can you set up a governance structure that is simple but effective?