It is not all about the familiar themes – since 2003 we have broadened our interests to embrace two new areas – Policy Governance and parental involvement in schools. In the case of the model developed by John and Miriam Carver, Policy Governance® has taken a while to get off the ground in the UK. Most of the work and case histories reflected US practice and we have not had a good UK example of how this approach to corporate governance can help organisations here. Now the Southend University Hospital NHS Foundation Trust have led the way for others to follow. Val Moore reported on this on 27th October.

Finally, Caroline Millar reports on how the new models of participation – involvement, engagement – are impacting schools, parents and teachers. Her piece focuses on the consultation on complaint handling in schools and how parental problems are handled (or not).

We call ourselves a consultancy that specialises in the user interest. What keeps us interested and involved and in business, is how that interest can manifest itself in so many different contexts while the principles underlying best practice can be so similar. Different diagnoses, different solutions but underpinning them all are the common questions – what do users think of this? Has anyone asked them? Has anyone listened? Has anyone done anything with what they have heard? What happens when people have a problem? Easy really.

The final question that comes up when looking back over 5 years – has anything changed?  Well Andrew inspired us all with a 2006 look at what the NHS will be like by 2015. We are almost halfway there and what has come true? Well the Department of Health seems to see things the Andrew Craig way. Allowing people to pay for their drugs was something Andrew took a look at in March this year when he pointed out that ‘topping up’ was something that Beveridge seemed to have explicitly anticipated when he wrote about the State leaving “room and encouragement for voluntary action by each individual”.  As far as the management ethos of the NHS as a whole is concerned, we will wait and see how PG will change all that.

In the meantime, it is still worth repeating a little Olympic-flavoured M-A-C joke from 28th November 2006 -

A parable of NHS reforms

(Elements are borrowed from several sources and sexed up a bit by us)

An NHS rowing team raced against a Japanese team. There were eight people in each team, of similar fitness, but the Japanese team won by a mile. How could this have happened asked John Reid? Top NHS management established a committee of analysts, which reported that the Japanese had seven rowers and one captain, whereas the NHS has seven captains and one rower. The experts called for restructuring of the NHS team. The new team comprised four captains, two service managers, and a director who also did the rowing. After a second lost race to the Japanese, the single rower was dismissed on the grounds of incompetence, and the management team received a bonus for strong leadership. A new NHS boat is currently being designed , but is reported to be running behind delivery schedule due to IT problems.

Let us see what has changed by the Olympic year of 2012 assuming we have not had to make a choice before then between funding bread and circuses or the NHS.

Their presentation was made at a workshop at Birkbeck College London University on 22nd October 2008 when over 30 people came together to hear more about Policy Governance®, the model developed by John and Miriam Carver. Since attending the Policy Governance Academy when it was held in the UK some three years ago, I have been a little frustrated by the lack of examples of UK-based work to put alongside the many implementation case histories from Canada and the States – a need now met with the Southend work.

Those who came to listen and learn were from many different parts of the NHS: Hospital Boards, PCTs, GP surgeries, specialist Councils for health care professionals, health regulators and health charities.  The delegates also heard  from Caroline Oliver Chairman of the UK Policy Governance Board (UKPGA) and a consultant and writer of three books on Policy Governance, Stuart Emslie CEO of the UKPGA and Ray Tooley inventor of OurBoardroom an internet-based tool for implementing Policy Governance.

Hearing first hand about the challenges and the benefits of becoming a Policy Governance Board was fascinating for me as a former non-executive director in a NHS Trust. The UKPGA and the London Centre for Corporate Governance and Ethics at Birkbeck College plan further workshops and the members of UKPGA who are consultants are ready and willing to help individual Trusts or other health organisations test out if Policy Governance could bring them the focus and strategic perspective they so badly need.

At a time when the word governance is bandied about with innumerable definitions and applications, the workshop was reminded why John Carver’s seminal book Boards that Make a Difference has sold over 1 million copies world wide and why his Policy Governance model is described by Sir Adrian Cadbury ‘father’ of modern day corporate governance, as “….a fully integrated and coherent system of governance, a significant advance in management thinking, as near a universal theory of governance as we at present have.”

Contact Information

For more information on Policy Governance® can help your organisation, please contact me Valerie Moore at M-A-C or you can reach Stuart Emslie at ukpolicygovernance@gmail.com or 07932 376562.
John Bruce, Chairman and John Gilham, Chief Executive of Southend University Hospital NHS Foundation Trust can be contacted at john.bruce@southend.nhs.uk. They prefer emails to phone calls.

The UKPGA submission focused on two key aspects: accountability and local determination of needs. Those have to sorted out first before service users can be clear about what their entitlements to services are.  But the NHS Constitution lacks a statement of accountability – ie there is no answer to the question “to whom is it accountable and for what and how is that accountability to be exercised?”

M-A-C previously tried to interest our (then new) Prime Minister in this when we suggested to Mr Brown back in June 2007 that in his enthusiasm for the NHS, he needed to be clear about what the institution was for. We are glad to see that Ann Keen has assumed the mantel of “Minister for the NHS Constitution”, so we can address our views to her.

As we said to Mr Brown, so we say to Mrs Keen.  The end of the NHS in England – what it is for – should be understood as: “The health of all people in England is maintained as fully as possible for a sustainable tax burden”.

It should be that simple  – and it would be if we were clear that the owners of the NHS are the people who have paid and who do pay for it and who use it.  We also need to be clear that the “p word” we should use more of is “power” not “patients”.   If we were clear about those things, then getting the work done through good management would be a great deal easier.

So we were pleased that the UKPGA’s submission stressed the need for a statement of accountability as

“a central plank of the Constitution which should represent the terms on which the public’s authority is passed to the organisations that, together, comprise the NHS. “

The Statement of Accountability should

“Give guidance to enable NHS boards to deal with the competing demands for accountability from:

1. Parliament as representative of the national public interest
2. Government as the executive of Parliament
3. NHS regulators as monitors of compliance with parliamentary legislation and government policy
4. Local communities as representative of the local public interest
5. Patients as consumers of NHS services
6. Staff as employees of NHS organisations
7. Other stakeholders.

“Whilst it is perfectly right and proper for the NHS to be accountable to the public-as-consumers for any promises it makes to them, it is also vital that it is accountable to the public-as-owners for making only those promises that it can afford to keep if it is to remain a sustainable organisation.” As UKPGA further explained, “No person or institution can be held accountable for something over which they have no authority. Thus NHS organisations cannot be accountable to their local communities if they have no authority to vary their nationally prescribed responsibilities.”

Access to healthcare services cannot be without reasonable limitation if the NHS is going to be accountable. The NHS Constitution should therefore be amended as suggested by the UKPGA: “You have the right to expect your local NHS to assess the health requirements of the local community and to put in place the services to meet those needs as considered necessary.”

The last three words are crucial to accountability because “local NHS boards [must] have the freedom to interpret the phrase “as considered necessary” and [be] able to prioritise and interpret nationally prescribed responsibilities in the light of local community needs.”

The “planned differences” [discussed on our post of 14th October] that result would be evidence that the local NHS was simply doing its job.  Holding it to account for the promises that it could afford to keep would then be much more straightforward for us as the owners.

Contact Stuart Emslie at the UKPGA at either ukpolicygovernance@gmail.com or 07932 376562.