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NHS bodies maintain good governance during the COVID-19 crisis

18 January 2021
  • NHS bodies in Wales have largely maintained good governance throughout the crisis, with revised arrangements enabling them to govern in a lean, agile, and rigorous manner

    This report focuses on how NHS bodies in Wales have governed during the COVID-19 crisis. During the crisis, all NHS bodies have had to plan differently, operate differently, manage their resources differently, and govern differently to deal with the unprecedented challenges and pressures presented by the pandemic. 

    This report is the first of two publications which provides an all-Wales summary of the Auditor General’s 2020 structured assessment work at NHS bodies. They highlight key themes, identify future opportunities, and share learning.

    In this report we comment on how NHS bodies adjusted their governance arrangements to cope with the unprecedented challenges presented by the pandemic. We found that all NHS bodies operated effectively with a sense of urgency and a common purpose to adopt lean and agile ways of working and achieve rapid transformation whilst also maintaining a clear focus on core areas of business and governance.

    By adopting lean and agile ways of working, NHS bodies have been able to:

    • hold more effective and efficient board and committee meetings;
    • ensure a clear focus on essential business and COVID-19 related risks and matters;
    • maintain openness and transparency by conducting virtual meetings online; 
    • ensure effective engagement with the public and their partners; and
    • make decisions at a more rapid pace.

    As NHS bodies move towards the full recovery phase and enter a post-pandemic world, they should seek to reflect on their experiences of governing during the crisis. 

    In terms of governance specifically, our report highlights several opportunities for the future:

    • Virtual meetings – NHS bodies should consider sustaining virtual meetings in some form as they have proven to be an efficient and effective way of working and have also enabled boards and committees to maintain and, in some respects, enhance openness and transparency.
    • Effective and efficient meetings – NHS bodies should consider retaining and refining some of their new ways of working to ensure meetings continue to be as effective and efficient as possible in a post-pandemic world.
    • Agile decision making – NHS bodies should consider retaining and refining agile approaches to decision making to enable and facilitate innovation, transformation and learning on an ongoing basis in a post-pandemic world.  
    • Reshaping strategy – NHS bodies should consider reviewing and reshaping their vision and priorities to ensure they’re appropriate for a post-pandemic world. 
    • Focused, targeted, and integrated assurance – NHS bodies should consider redesigning their governance structures and build upon existing arrangements to provide more integrated assurance to their boards and committees in future. 
    • Enhanced communication – NHS bodies should consider maintaining, and enhancing where possible, new forms and ways of communication introduced during the pandemic to sustain collaboration, partnership working, and public engagement in the post-pandemic world.
    In times of crisis, the challenge for all public bodies is to adapt their governance systems, processes, and structures to ensure good governance is maintained. Indeed, it could be argued that maintaining good governance is more necessary than ever during a time of crisis.  I have been assured that NHS bodies have largely maintained good governance throughout the crisis, with revised arrangements enabling them to govern in a lean, agile, and rigorous manner.  The challenge now for each individual body is to fully evaluate their new ways of working, consider the opportunities outlined in this report, and maintain the sense of urgency and common purpose created during the crisis to establish and embed new approaches to governance in a post-pandemic world. Adrian Crompton, Auditor General

    Notes to Editors:

    • This report focuses on how NHS bodies have governed during the COVID-19 crisis.
    • Our second report will focus on how NHS bodies have supported the health and wellbeing of their staff during the pandemic, with a particular emphasis on the arrangements they have put in place to safeguard staff at higher risk from COVID-19.
    • Our structured assessment work this year was designed and undertaken in the context of the ongoing pandemic. As a result, we were given a unique opportunity to see how NHS bodies have been adapting and responding to the numerous challenges and pressures posed by the COVID-19 crisis.
    • The Auditor General is the independent statutory external auditor of the devolved Welsh public sector. He is responsible for the annual audit of the majority of the public money spent in Wales, including the £20 billion of funds that are voted on annually by the Welsh Parliament. Elements of this funding are passed by the Welsh Government to the NHS in Wales (over £8 billion) and to local government (over £4 billion).
    • The audit independence of the Auditor General is of paramount importance. He is appointed by the Queen, and his audit work is not subject to direction or control by the Welsh Parliament or government. 
    • The Wales Audit Office (WAO) is a corporate body consisting of a nine member statutory Board which employs staff and provides other resources to the Auditor General, who is also the Board’s Chief Executive and Accounting Officer. The Board monitors and advises the Auditor General, regarding the exercise of his functions.
    • Audit Wales is the umbrella name for the Auditor General for Wales and the Wales Audit Office. Audit Wales is a registered trademark, but it is not a legal entity in itself.

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