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Proactive practical steps to good governance and collaboration in service change

Proactive practical steps to good governance and collaboration in service change

The process by which a service reconfiguration programme is established goes a long way to determining its eventual outcome.

The process by which a service reconfiguration programme is established goes a long way to determining its eventual outcome. Decisions taken early on will define relationships and form the basis upon which a wide range of development activities – such as clinical models, workforce and transport – move forward.

For the NHS to deliver against the Five Year Forward View, service reconfiguration programmes need to be established with sound governance protocols in place from the outset. But while good programme governance is critical, there are also practical steps that can be taken to support reconfiguration programmes in their early stages.

Experience suggests that there are four common elements in reconfiguration programmes that tend to become established part way through the process, often as a reaction to developing internal or external factors. However, identifying and establishing these steps early can strengthen programme governance and increase clarity and certainty across the local health economy.

1. A Communications concordat

Firstly, a communications concordat is a simple stage that can set out the way in which organisations involved in programme delivery will communicate externally. This provides more immediate alignment, clarity and certainty across the local health economy. As well as creating trust between organisations, it also increases public confidence as all parties are seen to be seeking the same outcome. Clear communication agreements become increasingly important in situations where proposed changes become contentious. With the right preparation in place, external communication will be more consistent and timely, with appropriate involvement from all parties.

2. Collaboration agreement

Secondly, collaboration agreements can be very useful, especially where large-scale programmes are being established. The programme team responsible for the day-to-day delivery of the reconfiguration will need to be clear about their delegations and the way in which decisions are to be progressed through the governance structure. A collaboration agreement can give confidence that appropriate checks and balances are in place to allow the programme to proceed effectively, while ensuring major decisions are escalated when required.

A collaboration agreement is also useful in describing the relationship between stakeholders in terms of the decision-making processes, especially where different bodies have different statutory duties and yet need to create a supportive relationship.

3. Public, patient and stakeholder forum

Thirdly, the development of the public, patient and stakeholder forum is often left to the later stages of the programme’s development and yet could provide early practical support. This type of forum can generate different perspectives within the programme and also provide insight into challenges that may develop later. This in itself is an opportunity for engagement, debate and for new approaches to be sought at an early stage.

With the NHS increasingly in the media spotlight, it is also important that the wider public feels able to inform the development of a service reconfiguration, rather than seeing themselves as a passive recipient. This requires genuine debate and a deeper consideration of non-clinical aspects. Clinical Commissioning Groups (CCGs) can enhance this by reflecting the concerns of the local community raised through their PPI forums and their own local focus.

4. Committee in Common/joint committee

Increasingly, as reconfiguration programmmes draw in specialised services and primary care, borders between CCGs and even between health and wellbeing boards will have less significance. Until recently reconfigurations were well served by Committees in Common that have allowed multiple CCGs to take decisions. However, as CCGs begin to work with NHS England to commission services requiring reconfiguration, joint committees will need to be established. Whilst traditionally a Committee in Common or joint committee need consider only the decision to implement the new model of care, a more robust approach would be to establish the committee at the beginning of the programme. This would ensure all parties work together in developing integrated plans through an open, collaborative process, which is supported by a clear audit trail.

Be proactive

Reconfiguration programmes are undoubtedly complex and robust governance is essential, both in ensuring effective management of the process and in seeking and maintaining public engagement throughout. While the above four steps may not be prescriptive from the outset of a programme, proactively addressing these issues upfront is likely to pay dividends as projects move into more complex and fast-paced phases.

By Simon Angelides, reconfiguration programme director – NHS Arden & GEM Commissioning Support Unit

NHS Arden & GEM CSU and NHS IQ have been running a series of webinars titled Navigating Essential Change. The series considers some of the key questions that need to be answered when thinking about service reconfiguration. The webinar recordings are available to view at


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