Recommendation 126

Code of practice for managing organisational transitions

The NHS Commissioning Board and local commissioners should develop and oversee a code of practice for managing organisational transitions, to ensure the information conveyed is both candid and comprehensive.  This code should cover both transitions between commissioners, for example as new clinical commissioning groups are formed, and guidance for commissioners on what they should expect to see in any organisational transitions among their providers.

NHS organisations have gained significant learning from the transition to the reformed NHS system in 2013. NHS England will continue to work with commissioners to build on this, so that information handed over in future transitions is comprehensive and candid.

The handover process from strategic health authorities and primary care trusts to the reformed NHS system was developed with guidance on effective quality handover from the National Quality Board, to address the requirements of managing organisational transitions. This will be used as a template for future transitions.

The key lessons on effective transition identified by the National Quality Board included:

  • the need for clarity of purpose with time for the system to understand and meet the requirements of a handover process
  • documenting information is an important discipline, but the most valuable part of the process was the face-to-face conversations between individuals
  • information should not only be handed over in order to reduce risk; the ambition for quality improvement should be handed over, so that services continue to improve for patients
  • documents need to be easy to access and navigate by the recipient, so that it is apparent where the areas of risk are in terms of quality. Too much information is as unhelpful as too little
  • the documents are for the benefit of recipients, and should tell them whatever they need to know in order to help them exercise their new accountabilities. They should not be confused with an attempt to record the achievements of the existing organisation
  •  triangulation of data (both hard and soft) did not always happen between all of the relevant bodies, such as the regulators, but when it did it was extremely helpful. We need to be much clearer about the requirements of our key stakeholders
  • it is vital that patient experience data is captured as part of the quality assessment and to find ways of engaging with patient groups as part of the process of triangulation
  • ‘looking and seeing’ should form part of the triangulation process wherever possible
  • whilst data was generally strong and comprehensive on the acute sector, we need to extend and improve our inclusion of data on the quality of primary, secondary and tertiary care, social care, ambulance services, screening programmes, offender health, mental health and the independent and third sectors
  • the responsibility for the handover should sit equally with both the receiver and the sender. i.e. if there are gaps in the documentation handed over, then it is the duty of the recipient to proactively seek to fill those gaps
  • the requirement to take handover documents to the public sessions of boards helped the process to be taken seriously, and was in line with the proposed new Duty of Candour. On the whole the media treated this information responsibly
  • embedding documents is not good practice, as the information can be lost as links and websites close down. We need to use technology better to ensure that documents are kept ‘live’ and electronically available to those who need it, with better version control;
  • some issues transcend individual organisations, and there may be a need for a small number of thematic handovers in order to maintain quality during transition.

NHS England will consider with clinical commissioning groups what further support and guidance might be required.

No further update is required. Please see response to the recommendation above