Briefing / System decision-making and governance

System governance decision-making, particularly in the context of financial and operational pressures, is complex.

This briefing explores issues around system governance and decision-making. It explores the tensions that can arise due to competing financial duties and identifies the key questions to be asked in shaping local governance arrangements.

Recognising that there is no one simple approach to making this work and that at this point in time each system is still developing its own arrangements, this paper sets out the context and key questions to be asked locally in shaping arrangements covering:
• Duty, authority and power
• Accountability, responsibility and
• Governance and delegation
• Differences in governance
• Barriers in integrated decision-making
• Collective decision-making
• Managing conflict
• Handling fundamental disagreement
• Conflict within an NHS organisation
• Assurance mechanisms

This paper will be revisited as arrangements have time to develop.