Governance, assurance and understanding the NHS

Governance, assurance and understanding the NHS

Watch the King’s Fund animation to discover the key organisations that make up the NHS and how they can collaborate with partners in the health can care system to deliver joined-up care.

This content relates to the following topics:

The purpose of these resources is to outline relationships and governance in the NHS. The title is ambitious because the NHS is always evolving to better meet the needs of populations and it will be useful to you to explore the other areas of this website too to better understand the NHS, such as ‘Building Trusted Relationships with Partners and Communities and Delivering High Quality Sustainable Outcomes.

The NHS is a complex system, in it’s own right, with different organisations and sectors delivering care in concert and partnership. Through Integrated Care Systems, NHS organisations will be in partnership with a wide range of organisations including local government and social care, voluntary, community and social enterprise organisations and private companies with the goal of better population health. NHS organisations also have varied accountabilities and relationships with Arms Lengths Bodies (ALBs), like NHS England and it’s regions, Local Authorities through Health Overview and Scrutiny committees and in the case of NHS foundation trusts, governors who challenge the board of directors and hold the non- executive directors to account for the performance of the board.

It should be noted that the organisation’s statutory duties remain as these new ways of working develop.  We will continue to add resources that reflect how things are changing – and if you find a great resource we’ve missed please let us know.

Robust governance enables organisations to understand and manage risk, plan for improvement and assure the board, stakeholders and the populations we serve that our organisations are safe and performing well.


Acronym buster by NHS Confederation 

Podcast: Watch the latest podcast produced in August 2022 by the Healthcare Financial Management Association on Introduction to NHS Finance

Resources: How does the health and social care system work? How is it changing? The King’s Fund – Key pieces of The King’s Fund work including podcasts, extensive “explainer articles” and thought pieces around health and social care across policy areas and delivery challenges.

Timeline: Health and Social Care Explained – the NHS reform timeline till January 2019 Nuffield Trust

Overview: Integrated care systems: how will they work under the Health and Care Bill? King’s Fund 2021

Resources: Health and social care explained Nuffield Trust This page from the Nuffield Trust covers a wide range of resources and signposting which includes policy, numbers and data explained, toolkits and methods and a “topics explained” section where the Nuffield Trust delve deeper into subjects relevant to the health service.

Tool: NHS corporate governance map – brings together the key guidance and models to support effective corporate governance
within the NHS – Healthcare Financial Management Association (HFMA) March 2022

Briefing: How it works – primary care finance and primary care networks Healthcare Financial Management Association (HFMA)

Finance: Series 1 – How finance works in the NHS: Healthcare Financial Management Association

Resource: NHS corporate governance map healthcare Healthcare Financial Management Association 2020 – Helpful tool that maps key NHS corporate governance guidance includes helpful links including around specific areas for board assurance.

Website: Department of Health and Social Care’s agencies and partner organisations – details of health arm’s length bodies and links to their websites – helpful for understanding the range of organisations engaged around health. Updated Nov 2021

Guidance: Integrated Care Systems These documents set out the headlines for how we will ask NHS leaders and organisations to operate with their partners in Integrated Care Systems (ICSs) from July 2022 and guidance in respect of what the employment commitment is, its application in practice and how it affects people.

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For further information on the commissioning landscape read How Commissioning is Changing and sign up to the Future Health and Care bulletin for the latest news and events on integrating health and care across the country.

Resources: ‘The NHS after the Health and Social Care act 2012’ Dated 2018

PDF guide: National Audit Office – A short guide to the Department of Health and NHS England Dated Sept 2017 – This document refers to Integrated Care Boards in their earlier form of Sustainability and Transformation Partnerships, but gives a good overview of how the roles and accountabilities of Department of Health and NHS England.

Report: ‘The NHS at 70: How good is the NHS?’ Published 25/06/2018

Briefing: Investing in The NHS long term plan – The Health Foundation 2019

Book: HFMA Introductory guide – NHS finance Health Finance Managers Association


  • In your first few months make time to seek out other senior leaders in the organisations around you and to understand their perspectives, priorities and current relationships ahead of meeting them in the course of business.

  • Take a “no surprises” approach with partner and oversight organisations – there may be support offers.

  • Keep asking questions of your teams to ensure you know the causes of issues, how they link to other factors you are facing and that you have a credible plan and the capacity to solve or mitigate these – for your own and board’s assurance.

  • The strategic landscape is complex – keep checking your understanding and raise risks and issues.