Comments from ACCA to The Institute of Chartered Secretaries and Administrators, 24 July 2013.
Is the content of the draft CCG code of governance easy to understand?
Overall, we found the draft code easy to understand and consider this to be a good starting point for outlining governance principles to clinicians.
The document does, however, leave room for many different interpretations on how best to meet the criteria. We also noted that some of the principles overlap and thought that this reduced the clarity of the document.
We consider that some of the points listed as ‘Key questions for the CCG’ should really be included within the recommendations for core principles. Under Principle 2, for example, in our view ‘full records of delegated decision making’ should be a core requirement and not a question.
We also question why the first option listed under Principle 6 ‘…members acting in the best interests of the CCG, its patients and the public… ’ is effectively presented as an option? We consider that it should be a principle in itself, arguably the main one.
Is the language in the draft CCG code of governance appropriate for your governing body members, GP member practices, staff and others interested in the governance of CCG?
We have concerns about some of the language used throughout the document. In particular we consider it to be overly permissive by using the word ‘could’ rather than ‘should’ in setting out how each principle ‘could be achieved’. We believe that this undermines the strength of the guidance being given – e.g. under Principle 6 the guidance appears to suggest compliance with the Nolan principles is an option; we consider it should be encouraged.
Although we understand the need for some variation in usage, when it comes to the application of the principles of good governance we believe a more precise approach is required.
We consider that Principle 6 would be made stronger by amending the wording to say: ‘Governing bodies to have effective processes for decision making...’.
We think it would be helpful to reconsider the wording of paragraph 3, page 3: ‘Good governance is an important aspect for delivering that transparency and accountability, but may not be well understood by those likely to be involved in running CCGs.’ We found this to be a rather negative comment on the appointment of CCG boards and the authorisation process run by the Department of Health.
We are unhappy about the use of the word ‘defensible’ in the last bullet point on page 11. It suggests that the aim is being able to ‘defend’ an action irrespective of whether it is right or wrong. We consider that ‘defensible’ might be better replaced with ‘justifiable’.
For those working within CCGs, is the draft CCG code of governance flexible enough to adapt to your CCG’s needs?
The code is certainly flexible in the way it is written. It is, however, perhaps too flexible. Members might benefit from a clearer understanding of minimum requirements.
What are the most useful aspects of the draft CCG code of governance in relation to your work and interactions with CCGs? As someone who works with CCGs or as part of a CCG?
We consider the section on accountability to be helpful as well as some of the question prompts listed under each Principle.
How could the draft CCG code of governance be improved for those working in or with CCGs?
Overall we consider this to be a good starting point but consider that the Principles would benefit from the following enhancements:
In addition there is a risk of conflict of interest in officers who provide a service to more than one CCG.
In addition we consider:
We consider that the code would benefit from:
What other information could be included in the draft CCG code of governance?
Reference needs to be made to putting effective counter fraud awareness training in place for all members and to providing access to an appropriate counter fraud service with the expertise to advice on the specific set of fraud risks pertinent to a CCG.
Mention should also be made about Codes of Conduct and the Annual Review of governing body / CCG effectiveness and requirements for audit and remuneration committees.
What, if any, supporting activities and documents would help you to implement the draft CCG code of governance principles within your CCG?
The code references a range of resources published by NHS England covering specific components relating to governance. It would be useful to provide greater clarity regarding the status of these documents/templates regarding any minimum/mandatory requirements – e.g. where local departure must be specifically considered and documented.
Reference could also be made to the document produced by the Professional Standards Authority: Standards for members of NHS boards and Clinical Commissioning Group Governing Bodies in England (www.professionalstandards.org.uk).
How would the draft CCG code of governance principles help your organisation to meet its objectives?
Although we consider the draft code to be a good starting point we believe it needs further refinement before it could realistically be called a ‘model’ code of governance.
What other comments do you have regarding the draft CCG code of governance?
Our overall impression is that the code is focussed very much on stakeholder engagement but doesn't quite achieve the balance between inward (e.g. decision making, accountability, audit) and external (working with stakeholders, engagement and reporting).
We also consider there should have been greater reference to existing governance models; this would aid consistency, comparability and would ease understanding.
We found the context of the code to be rather vague and are concerned that in some places it may be conveying the wrong message. Paragraph 2 on page 5, for example, makes no reference to the views or potential requirements that will be set by NHS England. It discusses ‘hoping’ that principles will be adopted and that a statement will be included in the annual reports without referencing any actual reporting requirements that might be made by NHS England. The paragraph also states that CCGs should provide explanations for those instances where they do not follow high level principles, but makes no reference to any potential action that NHS England may take in these cases. The wording suggests that not following the high level principles is acceptable subject to explanation but this is unlikely to be the case in practice.
In our view the draft guidance should spell out at the outset that CCGs and their governing bodies are regulated by the NHS England and that governing bodies are required to comply with ‘such generally accepted principles of corporate governance as are relevant to it’. There should also be a statement of the proposed status of the guidance too.
As stated above, we believe that the code would benefit from greater clarity on some core minimum requirements and on areas where greater flexibility is permissible. This may help organisations resolve differences that may occur and promote greater consistency.
We certainly welcome the idea that the code will be refreshed and amended after one year.
Footnote 2 states that’ information regarding the roles of each governing body member can be found in Appendix C’. But this is not the case. Appendix C is a list of references.
Footnote 3 refers to Appendix 3 which does not exist.