The importance of Good Governance for Care Home providers.

The team at Swift Management Services Limited often find that the term ‘Good Governance’ is misused and misunderstood. There is further confusion caused as local authorities and NHS professionals use the term: ‘Clinical Governance’ and bankers and auditors use terms such as ‘good financial governance’. These terms leave some providers in a quandary and we often hear comments such as “What is good governance, what do I have to do?”

We hope that we can help demystify the terminology for providers. In the simplest of terms, Good Governance is: putting processes in place and ensuring that your team do what you say they do. The processes in place should reflect best practice guidelines where they exist.

The management team, or provider needs to be able to demonstrate they monitor processes and take action to ensure that what is happening, is what they believe should be happening. The process of governance includes policies, procedures, forms and documentation, reports, and inspections from providers.

One of the most seen business governance failures is fraud taking place, and business owners not just in the care industry looking back in wonder as to how it happened. The banking policy and good business practice would dictate that all financial transactions are signed by two authorised people, or where transactions are electronic two people authorise them.

In many instances and based on a level of trust, one of the two signatories may sign an entire cheque book of cheques. The second person is then able to complete the cheque and add their signature or in the case of electronic banking one person gives their security information to the second to allow one person to undertake both parts of the authorisation process. For much of the time the process appears to work, and everyone is happy until something goes wrong and fraud is committed. One of the first questions asked is what governance checking was in place. In short, the management of the organisation did not recognise the practice before an issue arose and significant loss occurred.

Above is only one example of poor governance, but throughout the care industry there are multiple areas of the business where good governance is essential. These relate to the business, residents, and their care.

Any provider should be asking themselves if they are able to say that they know with certainty that what is supposed to be happening is happening. One governance tool used in large businesses is the auditor’s report, which should be a tool that is used to advise stakeholders about practice. Some care home providers view the regulatory report as a governance tool. That view is not appropriate, and a regulatory report should never be a governance tool. Governance should be an ongoingmethod of internal review, long before an inspection takes place.

The governance process can include, but is not limited to, provider visit reports, and a review against recognised clinical tools, to ensure that care trends are being maintained and action is being taken to ensure standards of care.

Good Governance and service improvement plans go hand in hand, and can make the difference between grades in effective, caring, responsive, safe, and well led. The Swift Management team can provide good governance audit tools, service improvement plans and provide governance audit reports. Providers who are regularly in a service, may see things so often that despite not being best practice, become the norm, and are no longer seen. Therefore, an external audit report can really help in the governance journey.

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