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Aspirant Foundation Trusts were encouraged to complete board governance assurance framework (BGAF) reviews to be used by the Board of a Trust when making judgements about progress towards becoming a Foundation Trust.

Tavistock Consulting formed a partnership with management consultants Cap Gemini, Cass Business School and accountancy and business advisory firm BDO to carry out this work, a multidisciplinary partnership usefully mirrored the multifaceted concerns of the aspirant trusts. The framework for the review was based on the governance framework from the TDA (Trust Development Authority, now part of NHS Improvement) and augmented by Tavistock Consulting’s emphasis on group dynamics. This approach enabled us to uncover the patterns of behaviour that could have undermined or constrained the effectiveness of the governance system. We also focused on the design of the systems themselves, particularly for integrated systems of care, to think about how to make systems of accountability more visible, rather than simply demanding more and more data from managers. We worked with boards up and down the country using a process that included confidential interviews, stakeholder surveys and staff and service user focus groups. We also undertook board observations, followed up by feedback and facilitated sessions with the Chair and Chief Executive of a Trust to together challenge their existing clinical governance frameworks and highlight potential areas to address.

• Boards were able to develop closer relationships between their members, increasing trust and their capacity to conduct difficult conversations and engage with contentious issues at a deeper level. • A number of boards redesigned committee structures to augment horizontal governance. • Boards reaffirmed their broader strategic and future focus, allowing the executive to carry fuller responsibility for operational performance. • Boards rethought their relationship with Councils of governors. • Where highlighted, Boards overhauled the induction and review systems for directors – both executive and nonexecutive.

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