Precision in place: the beating heart of the new era of governance

Good governance demands precision. It requires high levels of discipline and focus which help provide the foundation for strong and effective organisations, partnerships, and collaborations. That much is agreed.

So, in a world of increasing complexity, uncertainty, and expectations, this should surely be a given; the basis for a golden era of governance. And no more so than in the maelstrom of ambitions, opportunities, threats, and conflicting needs that currently define the world of health and care.

But sadly, this is not yet the case.

The importance of collective mindset

It might seem unfair to expect rigour at what is still an early stage in a process of fundamental change in the fraught dynamics of health and care. We recognise the process will take time and require energy levels and capacity challenged by the effects of the last year.

But at this early stage is precisely when a clear, collective mindset, supported by guiding principles built around good governance and shared risk appetite, is vital. Having precision built in from the outset will help address tough choices and support the shifts in power and relationships at local level on which the future depends.

Although there are welcome signs of discussion about governance there are precious few examples of these design principles explicitly set out or being shared between policy makers and local leaders or with the public. There is a lot of aspirational narrative, but how precise are systems being, for example, about the independence and scrutiny on which good governance is built?

The contributions of governance in place

This absence is not surprising given the national framing of systems and place lacks depth of definition or understanding, and is now, largely unhelpful. The specific contributions of governance at place and in health and care systems should deliver different but complementary outcomes. Their focus and style ought to reflect their purpose:

• place being more expansive and inclusive, growing aspiration

• mobilisation of assets and mitigation of risks involved between partners funded from multiple sources

• system being about outcomes assurance and effective use of Treasury-funded assets to support prevention and improved population health.

Nor are there compelling guiding principles of good governance evident within policy thinking, nor enough precision around how the principles of subsidiarity might be applied to best effect to complement governance models.

Opportunity for local determinism

There is of course more to come in way of central guidance in the weeks ahead, but this will still leave space for a high degree of local working through of the outcomes which good governance should deliver.

This opportunity for local governance is being taken with varying degrees of confidence in local places and systems. But progress still feels more reliant on historical working patterns and personal working relationships than precision on accountabilities and outcomes which pass the tests of good governance in action. Governance is maybe being left to one side, to be resolved further down the line. This is dangerous, if true.

Among the signs of real progress towards good governance in action could be:

• greater visibility on design principles based on good governance, driven by risk appetite and aligned with the principles of subsidiarity

• less leadership time spent restating problems and more spent on developing and sharing solutions

• better differentiation of place and system and the precise roles and contributions of governance in each (and how they interconnect)

• clearer expression of a collective mindset which crosses normal boundaries in ways that make sense to the public

• precision about how the public feature in local governance in a way that has consequences for power

• a decisive move from generality and ambition to measurable impact within clear timelines

Illuminations

• Even with further central guidance, there will be significant scope to make something local and high-impact happen

• Therefore, shared assumptions on the distinctive purposes and outcomes of governance of place and of systems and their interconnection) need to be more precise

• Design principles for place and system should be explicit and include rigour around what good governance looks like and how subsidiarity principles will be applied in detail.

• All the above should be clear to the public

• Given other pressures dedicated support and independent governance, expertise may well be needed during the next phase towards April 2022 implementation

If you have any questions about or would like help with anything covered in this briefing, please call us on 07732 681120 or email advice@good-governance.org.uk.