Recommendation 15

Comprehensive governance standard

Accepted in principle
All the required elements of governance should be brought together into one comprehensive standard. This should require not only evidence of a working system but also a demonstration that it is being used to good effect.

The Department of Health will consult on new regulations which introduce fundamental standards of care and a clearer focus on governance arrangements for complying with them.  The Care Quality Commission will consult on and issue guidance for providers, which will cover all elements of governance covered by the new regulations. Subject to consultation and Parliament, the regulations will be put in place during 2014 and then implemented progressively in all sectors.

In June 2013, the Care Quality Commission issued A new start – Consultation on changes to the way CQC regulates, inspects and monitors care. This set out proposals to assess providers and services with regard to five key questions, one of which is whether the service is well-led. Being well-led particularly concerns the culture, leadership and governance of the service and the provider. On 17 October 2013, the Care Quality Commission published the responses to the consultation in A new start: Responses to our consultation on changes to the way CQC regulates, inspects and monitors care services, which showed that there is broad agreement with the new approach.

The Care Quality Commission has introduced a new approach to inspection, including making judgements on five dimensions of quality,* one of which is how well-led a service is.  This includes the effectiveness and existence of governance systems. The Care Quality Commission is working with Monitor, the NHS Trust Development Authority and NHS England to ensure that there is a single, coherent approach to oversight of governance. This will result in a single aligned framework for monitoring governance, coherent across all the elements of governance which are covered variously by the Care Quality Commission, NHS Trust Development Authority, Monitor or NHS England’s areas of responsibility.

*Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people? Is the service well-led?


Between January and April 2014, the Department of Health consulted on new Fundamental Standards regulations. These have been approved by Parliament and will come into force for all providers of health and social care in April 2015. The consultation response was published in July 2014.

To meet the fundamental standard for good governance, providers must have oversight of planning, delivery and monitoring of all care and treatment. It must know what action is taken to mitigate risks to the quality and safety of care and treatment, and what action is taken in response to issues raised by monitoring activities. This includes ensuring that it has access to all relevant information about its service(s), including information about the experience of service users and others. The provider must also take timely and appropriate corrective action where there is a risk of a regulatory breach occurring, or where a regulatory breach has occurred. Additionally, the provider must securely maintain appropriate and accurate records as follows:

  • Records about all aspects of the care and treatment of each service user.
  • Relevant records about persons it employs for designing and delivering care and treatment.
  • Any other records which may be appropriate for managing the carrying on of regulated activities.

The provider must also continually evaluate and make improvements to the systems and processes that are used to achieve the above.

Information on the new inspection model programme and the Care Quality Commission consultation is given under recommendation 14.