Trusts 'can no longer work on trust'

Wednesday, April 29, 2009

The boards of NHS trusts and foundation trusts shouldn't be so quick to accept information they're given about how hospitals are run and should challenge it much more, according to the Audit Commission, which claimed there were "significant gaps" between processes in theory and how they are applied in practice.

In its report 'Taking it on Trust', which looked at how boards assure themselves that internal controls are in place and operating effectively, the commission asserted that board members are not always challenging enough, board assurance processes must be applied "more rigorously", and the information received by boards is not always relevant, timely or fit for purpose.

NHS trusts and foundation trusts should also look at their risk management arrangements, including the way risks are reported to boards, they should make better use of internal audits and clinical audits to provide greater assurance to boards, and they should carry out "systematic data quality reviews", the report said, adding that current controls and assurances are often poor, making it difficult for boards to be clear that the assurances they receive are sound.

Steve Bundred, chief executive of the Audit Commission, said: "Our evidence suggests that, while processes are in place, many board members at NHS trusts and foundation trusts are not always getting the right information that is needed to go hand-in-hand with the critical nature of work in hospitals.

"The NHS has, in many cases, been run on trust. But those who are charged with running our hospitals must be more challenging of the information they are given and more sceptical in their approach. Healthcare is inherently risky and complex, and assurance is not easy in the public or private sectors. To do their jobs properly, NHS board members must review their risk management arrangements so that they can be absolutely confident that their trust is providing high quality care by well-trained staff in a safe environment all of the time."

The NHS Confederation said the best boards were the ones where senior leaders didn't just rely on box ticking for what was happening in their organisations.

Chief executive Steve Barnett said: "It is absolutely vital that hospital leaders are fully connected to what is going on in all parts of their organisations and that means adopting the questioning and sceptical approach to information which the Audit Commission is calling for. In the best organisations, board members do not just believe something because they read about it in a report – they base their judgements of what the situation is on the ground by actually getting out and experiencing it for themselves."