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What is governance and how do we deliver it?

Governance is a word used to describe the ways that organisations ensure they run themselves efficiently and effectively. It also describes the ways organisations are open and accountable to the people they serve for the work they do.

All effective public and private sector organisations want to have good governance. For an NHS organisation like Sussex Community NHS Foundation Trust, good governance is about creating a framework within which we:

  • Provide our patients with good quality healthcare services.
  • Are transparent in the ways we are responsible and accountable for our work.
  • Ensure we continually improve the ways we work.

Good governance is maintained by the structures, systems and processes we put in place to ensure the proper management of our work, and by the ways we expect our staff to work.

It’s also about how we scrutinise our performance and deal with poor practice and other problems. And it about how we identify and manage risks, whether in terms of patient care, to our staff, and to the organisation as a whole. For example, by ensuring we manage our finances effectively.

The governance framework

The Audit Commission (2002) defined governance within the NHS as: “The systems and processes by which health bodies lead, direct and control their functions, in order to achieve organisational objectives and by which they relate to their partners and wider community.”
The Department of Health 2006 defined integrated governance as: “Systems, processes and behaviours by which trusts lead, direct and control their functions in order to achieve organisational objectives, safety and quality of service and in which they relate to patients and carers, the wider community and partner organisations.”

The structures, systems, processes and behaviours NHS bodies have for ensuring good governance include:

  • Standing Orders, Standing Financial Instructions, Reservation of Powers to the Board and Scheme of Delegation.
  • Requirement for a statutory board, and requirements on the committees that support the board.
  • How line managers operate, including codes of conduct and accountability. 
  • Business planning.
  • Procedural guidance for staff.
  • Risk register and assurance framework.
  • Internal audit.
  • Scrutiny by external assessors including the Care Quality Commission, external audit and Monitor.