Session 3: Structures, laws and regulatory frameworks Claire Lea, Wednesday 20 September 2017, 4pm My microphone is currently muted
Record session
Session 3: Governance structures and individual duties Claire Lea, Wednesday 20 September 2017, 4pm
Today’s plan • Recap and introduction • The structure of the NHS • The law • Other regulatory frameworks • Concluding remarks
Recap on last session • Definitions of governance • Complexity and diversity of stakeholders • Management vs governance
NHS landscape • NHS Constitution • Statement of NHS accountability providing care, commissioning care, improving public health, empowering people and local communities and supporting the health and care system • NHS Structure • Five Year Forward View
NHS Improvement
Special measures
Governance and the law • Health law ( also known as Public Law) • Laws on patient and public involvement • Laws on transparency of information, mental capacity, human rights, bribery, manslaughter • Company law Can you name a key piece of legislation or code for each of these areas?
Statutory duties - Public and patient involvement HSCA 2012 included two complementary duties for CCGs and NHS England with respect to patient and public participation. (1)to promote the involvement of patients and carers in decisions which relate to their care or treatment. (2)to ensure public involvement and consultation in commissioning processes and decisions. These arrangements must be included in a CCG’s constitution. It requires the involvement of the public, patients and carers in: • the planning of commissioning arrangements, which might include consideration of allocation of resources, needs assessment and service specification • any proposed changes to services which may impact on patients.
Guidance - Engaging people (Sept 2016) Outlines the requirement for public involvement in relation to STPs. It suggests: • using lay representatives and establishing patient reference or advisory groups; • considering and carrying out formal consultation with enough time for the public to make their views heard; and • testing options with local councils and other important stakeholders, where possible by building on the work of existing bodies such as health and wellbeing boards (HWBs). CCGs, local authorities, NHS trusts, FTs and NHSE all have separate, but similar, obligations to consult or otherwise involve the public
Voluntary or compulsory regulation • Comply or explain • Apply or explain • Apply and explain Pros and cons of voluntary or compulsory regulation
Past question – June 2017 You are the Company Secretary at Robson CCG (‘Robson’) and it became clear during the last governing body meeting that the lay members are confused about the CCG’s duty to involve and duty to consult during significant service reconfigurations. Robson is looking to work more closely with its two local authorities to integrate health and social care in respect of care for the elderly. This will result in significant changes in the way that care is delivered within the community. There have also been discussions about the CCG’s duties in this regard at the local Health and Wellbeing board. Required Write a report for the next meeting of the governing body, addressing the following issues: (a) The role of the Health and Wellbeing board and its responsibilities in respect of involvement and participation. [Note: you should not refer to Robson in this part of the question.] (8 marks) (b) Good practice in the involvement of patients and the public. [Note: you should not refer to Robson in this part of the question.] (8 marks) (c) Robson’s duty to involve and duty to consult, which stakeholders it might be relevant to consult and the possible consequences of failing to comply. (9 marks)
Examiner’s comments 50% of candidates managed to scrape a pass on this question but demonstrated little knowledge of the background legislation for the requirement to involve or duty to consult. A worrying position given the increasing amount of engagement necessary to successfully deliver the level of collaboration and service changes required by the Five Year Forward View. For the remaining scripts most of the substance of the answers was colloquial and not based on the clear guidance and strategies set out in the Handbook. The sample answer sets out clearly the source legislation and best practice guidance from which the answer should be structured. Average score 9.7%
Suggested answer (b) Source Guidance Documents 2 Transforming Participation in Health and Care; Real involvement: working with people to improve services; Sustainability and Transformation Plan guidance 1 Engaging peoples’ communities in the development of the Sustainability and Transformation Plans Principles of good practice in involvement 6 Ladder of Engagement, Engagement Cycle, happens early and throughout, inclusive, fit for purpose, transparent, influential, reciprocal, proportionate to the issues, core business, impactful
Suggested answer (c) Duty to involve patients 2 - HSCA 2012, NHS Act (section 14z), Transforming Participation in Health and Care 2 - Arrangements included in Robson’s constitution; Duty to consult/public participation consult on planning, on development and consideration of changes, on decisions affecting operation Consequences of failure of duty 2 - Judicial review, unlawful decisions, legal costs, Stakeholders to be included 2 - public, patients and carers, local authorities and relevant Health and Well-being Boards plus NHS providers locally and regionally as well as its staff and its member GP practices Application to scenario 2 - Statutory obligation, impact on reputation, key role of local authorities, unable to make decision and implement changes
Following this session • Session slides and content • Reminder - deadline for November exam is 1 October • Session 4 on The Board’s Role and Directors’ Responsibilities : Thursday 21 September, 4pm • Further questions
Thank you
Task 1 Practice task 1 (due Friday 29 September 2017) Meeting targets has been used as the measure of the quality of trust leadership because ‘‘compliance was an indication that boards could effect change within their own organisations where their lesser colleagues might struggle’’ John Coutts, NHS Providers
Task 1 Task 1 requires you to set out: The responsibilities of an NHS board or governing body (8 marks) How its governance procedures would meet these responsibilities and (10 marks) How does the well led framework move boards away from the use of targets as an assessment of the board’s effectiveness? (7 marks)
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