Doing it Differently, Doing it Right

18 January 2021
  • Rethinking NHS governance in a post-pandemic world

    Our report – Doing it differently, Doing it right? – provides an overview of how NHS bodies have governed differently during the COVID-19 crisis. In this blog, Dave Thomas and Darren Griffiths from our NHS Performance Audit Team highlight the key opportunities presented by the crisis to establish and embed new approaches to governance in the NHS in a post-pandemic world.

    The pandemic has forced the hands of all NHS bodies to redefine their traditional systems, structures, and processes of governance and embrace new ways of working to deal with the unprecedented challenges and pressures presented by the pandemic. 

    Throughout the crisis, NHS bodies have demonstrated they can adjust their governance arrangements to support swift decision making and leaner and more agile ways of working, whilst also maintaining oversight of core areas of business. 

    As they slowly move towards the full recovery phase, it would be a mistake for NHS bodies to simply return to the way things were done before the crisis. There are some real opportunities to continue doing things differently whilst also doing them right in a post-pandemic world.

    Our report highlights a number of such opportunities to embed new approaches to governance in the NHS in a post-pandemic world. Many of these are quite simple in nature.

    Sustaining virtual meetings and public engagement

    Virtual meetings have proven to be an efficient and effective way of working. In many ways, they have enabled boards and committees to maintain and, in some cases, enhance openness, transparency, and public engagement. Also, given the level of investment that occurred during the pandemic to support and facilitate virtual working, it makes sense for NHS bodies to sustain virtual meetings in some form in the future (eg, for their Annual General Meetings) as well as maintain new approaches to public engagement (eg, enabling members of the public to submit questions ahead of board meetings).

    Maintaining effective and efficient meetings

    The crisis forced NHS bodies to adopt working practices that would allow them to hold leaner and more focussed meetings, for example: 

    • using streamlined agendas, including the use of a consent agenda;
    • enabling focused reporting, including greater use of verbal reporting; and
    • allowing Independent Members to submit questions and comments on papers in advance of board and committee meetings.

    In our view, it makes sense for NHS bodies to retain and refine some of these new ways of working to minimise bureaucracy and enable more effective and efficient board and committee meetings to take place in future.

    Supporting agile decision making

    One of the key features of governance during the crisis was the introduction of structures and processes that facilitated rapid and agile decision making. Whilst this was necessitated by the need to react and respond at pace to the crisis, we feel there is scope for NHS bodies to retain new approaches to decision making to enable and facilitate innovation, transformation and learning on an ongoing basis. 

    There’s real value to be gained by NHS bodies properly evaluating and learning from their governance experiences during the COVID-19 crisis and to take the opportunities it has brought to develop new and better ways of working for the future. 

    In a previous blog - COVID-19 a catalyst for positive change? - our colleagues describe a framework which NHS bodies could use to pause, reflect and make sense of what has happened during the pandemic in order to use their experiences as a catalyst for driving forward positive change across a number of areas, including governance. 

    COVID-19 has had a devasting effect in so many ways, but using it as a catalyst for change will leave a positive legacy to some of the most challenging times NHS bodies have ever experienced.

    Also see our blog on governance in local government during the pandemic ‘Local council democracy – coming out of lockdown’.

    About the authors

    Dave Thomas is a Director in Audit Wales with responsibility for the NHS Performance Audit Team, and the Audit Development and Guidance function.

    Darren Griffiths is an Audit Manager with responsibilities which include management of performance audit work for Cardiff & Vale University Health Board.