Leadership, safety and governance
The role that charities play in supporting the physical and mental health needs of individuals is increasingly important, particularly when it comes to more personalised care, as envisaged in the NHS Long Term Plan. Demand for services is growing as they play an increasingly vital role in early intervention schemes, community care and the development of integrated services.
Charities involved in the provision of complex mental health and learning disability services face unique challenges as multiple-site providers. As a result, questions can be raised around the liability of leaders in the sector when it comes to risk and delivery of services. Good governance structures are vital to safeguard patients and the reputation of the charities themselves, particularly as many charities rely on donations from the public, as well as grants from funders.
The Care Quality Commission (CQC) estimates that charities and other third-sector organisations are responsible for delivering around a fifth of care services in England. They provide a wide range of services in a range of locations for people of all ages, and many with complex physical and/or mental health needs. Demand for, and scrutiny of, these services is set to rise as the focus moves to providing more personalised care in a community setting.
In addition, while the 2018/19 CQC State of Care report rates the majority of adult social care services as good (80%) or outstanding (4%), it also sets out serious challenges facing the sector due to funding cuts and high staff turnover, which can impact leadership, training and safety.
As the sector expands into more areas, it needs to ensure leadership, governance and safety procedures satisfy its regulators the CQC and the Charity Commission.
The CQC is increasingly interested in assessing whether services and the organisations providing them are well-led. Its scrutiny is becoming more punitive. Where it finds evidence of patient safety-related offences, it has not shied away from sanctions, including fines and criminal convictions. As complex multiple-site providers – often for individuals with multiple physical and mental health needs – charities risk significant exposure here.
The Charity Commission, which regulates the governance of charities by their trustees, wants charities to provide more evidence of the impact they are making – whether providing services, or on campaigning issues. The Charity Commission is also taking an increasingly interventionist approach, evidenced by its recent successful court application for a finding of contempt of court against two former trustees who failed to comply with an order to supply evidence and documentation to the regulator.
A recent report by the Charity Commission, The Value of the Charity Sector, urges charities to do more. It says the sector can no longer rely on being given the benefit of the doubt by the public, who want reassurance that organisations are behaving charitably as well as delivering on their purposes.
The Commission expects to see evidence of good leadership demonstrated in how trustees collect and manage complaints and concerns, how they report serious incidents and how honest and open they are when things go wrong. This increased scrutiny is bringing the sector more in line with regulation designed for healthcare providers.
To add to the regulatory and governance burden, new Liberty Protection Safeguards (LPS) are likely to come into effect in 2020 to replace Deprivation of Liberty Safeguards (DoLS). Although LPS will clearly have an effect on the sector, with significant changes in responsibility for care homes particularly, it is unclear at this stage what that will look like in practice.
In this report, we speak to charity sector leaders to examine the state of leadership, safety and governance, looking at areas of excellence, areas that require improvement and how good leadership should work when things go wrong. Experts from the CQC and the Charity Commission also offer insights and tips on improving these areas.
We would like to take this opportunity to thank our experts: the Care Quality Commission, the Charity Commission, Lesley Dixon (Chair of the Association of Chief Executives of Voluntary Organisations' (ACEVO) health and social care special interest group), Neil Heslop (Chief Executive at Leonard Cheshire), Tony Hunter (Chief Executive at the Social Care Institute for Excellence), Mark Ospedale (Director of Corporate Services at United Response) and Zoe Campbell (Operations Director, Transformation, Commercial and Outreach at Alzheimer's Society).
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LEADERSHIP, SAFETY AND GOVERNANCE
As charities provide more health and social care services, their leadership and governance will come under increasing scrutiny from regulators.
Click here to read article on leadership, safety and governance.
Charities must be able to demonstrate to regulators that they have strong systems in place to ensure they identify and act on safeguarding issues, and can collect and act on feedback from clients to ensure services are improved.
Click here to read article on the regulators.
GETTING LEADERSHIP RIGHT
Good leadership starts at the top and nurtures strong leaders at every level of an organisation.
Click here to read article on getting leadership right.
This report has shared a range of insights and ideas on strengthening leadership, safeguarding and governance – both to drive measurable improvements in services and that allow charities to demonstrate to regulators that their services are safe and well-led.
Click here to read the report summary.
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