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For some time many NHS boards have been aware that their governance arrangements have been too complex, leading to ineffectiveness.  The overlapping strands of clinical governance, controls assurance, financial governance, etc. and the competing demands of performance management data and external inspectorates have led to unnecessary duplication of activity.

In an effort to address this, the idea of 'Integrated Governance' was introduced to the NHS in a paper entitled 'Developing Integrated Governance' published by the NHS Confederation and written by Professor Michael Deighan of the Clinical Governance Support Team and Dr Roger Moore of the NHS Appointments Commission with support from  Sir William Wells, Professor Sir Ian Kennedy and Bill Moyes.

The paper set out the steps for integrating governance systems NHS wide.  Integrated governance was defined as -

'Systems and Processes by which Trusts lead, direct and control their functions in order to achieve organisation objectives, safety, and quality services and through which they relate to patients, the wider community and partner organisations'.

Integrated governance provides the umbrella for all NHS governance approaches.  It combines the principles of corporate/financial accountability with clinical/management accountability and it moves towards a single risk sensitivity process which covers all the trusts objectives, supported by a coordinated source of collecting information and subject to co-ordinated inspection. 

The concept was developed further at a Conference on the 26th May 2004 where speakers including Liam Donaldson, Bill Moyes, Ian Kennedy, William Wells, Nigel Crisp and Richard Douglas gave a strong  message that there needed to be a robust examination of current governance thinking and the manner in which it is understood and implemented by NHS boards. 

A key theme was that the information and governance systems currently in place are more focused on internal detail and external scrutiny, and are not a responsive methodology for ensuring that the board has the right level of information to realistically discharge their duties.

An active programme of work is now in hand to unite the various strands of governance within a common framework, address the issues of overlap, and provide a system which will empower boards to govern.  The outline framework will have the following strands:-

Working to the Department, Michael Deighan is leading the work with the aim of ensuring that the basic building blocks of Integrated Governance are in place by April 2005 with roll-out and implementation over the following 2 years. 

The work programme will involve wide consultation through a representative group of chairs and non-executive directors from all sectors of NHS organisations together with individuals involved in the strategic development of governance systems in the NHS and the associated agencies, who have a responsibility for inspection and review of healthcare governance activity.  An essential criterion is to incorporate the Healthcare Standards and Monitor requirements into a unified regime.

The programme has already identified 'blockages in the system' which militate against the full integration of governance mechanisms and  the over expectation boards still have on central guidance whilst they are obliged to govern locally on a set of locally interpreted priorities. 

The framework will be in place by April 2005.