Tayside NHS Board
Telephone Number 01382 818479
Fax Number 01382 424003
11 October 2010
Mr Mark Aggleton
Scottish Government Health Directorate
ABW/DH/aw/1110 M Aggleton
By email: firstname.lastname@example.org
Dear Mr Aggleton REQUEST FOR COMMENTS ON THE ‘FUTURE APPROACH TO GOVERNANCE’ IN
I refer to the correspondence received from Dr Kevin Woods and thank you for the opportunity to
comment on the discussion document ‘Future Approach to Governance in NHSScotland’.
NHS Tayside welcomes the fact that NHSScotland is looking at governance arrangements as the last
substantive guidance on overall corporate governance was MEL(1994)80 which obviously precedes a
number of important corporate governance developments including the adoption of Clinical, Staff and
Information Governance for NHS Scotland as well as significant advances in corporate governance
approaches in the private and public sectors and importantly the events in Mid Staffordshire NHS
These events clearly deserve substantive discussion with the particular focus on whether governance
arrangements in the relevant areas are adequate and effective. However these draft proposals linked
to the NHSScotland Quality Strategy may have moved beyond their natural boundaries into wider
questions of corporate governance, without necessarily providing a cohesive, comprehensive model
of assurance and governance.
In the discussion paper there are also a number of references to wider Corporate Governance issues
which do not appear fully to reflect existing Corporate Governance guidance or linkages to other
governance strands (i.e. Staff, Finance and Information), as well as some areas where the distinction
between Corporate and Clinical Governance does not appear to have been drawn.
Much of the paper relates to what has historically been described as Clinical Governance. Whilst
there have been a number of recent developments including the introduction of the National Quality
Strategy; the guidance relating to the role, remits and purpose of Clinical Governance Committees
and indeed the fundamental purpose of Clinical Governance, has not been substantially amended
since 1998. Any revision could also usefully set out the relationship between Clinical Governance and
‘Care Governance’ as defined in Box A.
In paragraph 3 there is an implication that current governance systems are neither risk-based nor
proportionate. Risk management is an integral element of Corporate Governance and within the last
year all NHS Boards have been specifically assessed by NHS Quality Improvement Scotland
regarding their arrangements in relation to risk management.
King’s Cross, Clepington Road, Dundee DD3 8EA
Chairman, Mr Sandy Watson, OBE DL
Chief Executive, Professor Tony Wells
Mr M Aggleton
11 October 2010
Paragraphs 6, 13 and Annex B seem to imply that the Quality Strategy rather than a holistic and
comprehensive model of governance and assurance is the key driver of overall corporate
governance. Annex B in particular demonstrates a focus on clinical assurance to the exclusion of
assurance on all other governance strands.
The final bullet point could be taken to imply that a clear governance and accountability framework is
not already in place in NHS Boards. If so, this would appear to contradict the Statements on Internal
Control provided by NHS Boards across NHS Scotland which were supported by a series of internal
and external assurances.
We have provided our response to you on the Mid Staffordshire NHS Foundation Trust situation
which gives an overview of current local governance arrangements and includes the organogram of
our current governance structure.
In NHS Tayside we have already taken an important step to strengthen our approach to Governance
across all the strands of governance by the development of an Integrated Good Governance Group.
The purpose of this group is to provide assurance that NHS Tayside has robust integrated systems
and processes across all governance strands and will provide assurance that NHS Tayside operates
in terms of the Good Governance Principles from the Scottish Government.
This overarching group has a membership that covers all of the governance strands and includes the
Executive Leads from all of these areas along with Non Executive and partnership representation.
The remit of the Integrated Good Governance Group is attached for information.
We have also enclosed a copy of a report which was considered by Tayside NHS Board on
26 August 2010 and outlines our ongoing work to underpin the NHSScotland Quality Strategy with a
focus on the governance arrangement from Ward to Board.
Please do not hesitate to contact the Board Secretary, Ms Margaret Moulton on 01382 424011 or
should you require any further information.
Sandy Watson OBE DL Professor Tony Wells
Chairman Chief Executive
1. NHS Tayside response to Mid Staffordshire NHS Foundation Trust situation
2. NHS Tayside Board paper – Quality Strategy
3. NHS Tayside Integrated Good Governance Group remit