Holding to account for corrective action

Abstract

This is the fourth of four articles exploring a range of problem areas in Foundation Trusts (FTs), causing trusts to be identified by the FT regulator Monitor (now NHS Improvement) for special attention. These problem areas focus on the board's insight into business, the information available for decision making, the effectiveness of the non-executive challenge function, and how effective this is in holding to account. This learning is equally applicable to governing bodies of clinical commissioning groups. This final article in the series considers the key issue of holding to account for the implementation of board decisions, from perspectives both of the organisation and board executives. A number of areas are explored: first, the changing role of government and the public sector standards to which boards are held to account; second, the role of NHS leaders as public managers, who are explorers, agents and innovators; third, the pivotal chair-chief executive relationship that underpins the effectiveness of the board; fourth, the non-executive role in shaping the holding to account process; finally, the role of FT governors in their role of holding the board to account. For each area, problems are highlighted followed by recommendations for improving the effectiveness of holding to account in practice. The article concludes with a set of actions the board can implement in order to improve processes for holding to account.