From NHS Legislation to NUH Governance: Understanding Links to Accountability

NUH is committed to upholding the following Healthcare Principles:

1. Respect for Autonomy - Patients have the right to make informed decisions about their own care and treatment.
2. Beneficence - Healthcare professionals should act in the best interests of the patient, promoting their wellbeing.
3. Non-Maleficence - Do no harm, avoid causing unnecessary harm or suffering to patients.
4. Justice - Fairness in the distribution of healthcare resources and treatment, ensuring equal access to care.
5. Confidentiality - Protecting patient information and respecting privacy.
6. Accountability - Healthcare providers and organisations must be accountable for the quality and safety of care delivered.
7. Patient-Centred Care - Care should be tailored to the individual needs and preferences of patients, involving them in decisions.
8. Transparency - Open communication about treatment options, risks, and organisational practices.

The NUH Trust Board has ultimate responsibility for the strategy, performance and governance of the Trust. It ensures that the Trust complies with legal and regulatory obligations, delivers safe and high-quality services and operates in a financially sustainable manner. The Board holds executives to account, making key decisions on strategic direction, patient care standards and operational performance.

The Board is supported by various committees, namely: the Audit Committee, Quality Assurance Committee, Finance and Performance Committee and People and Culture Committee. These committees ensure that there is focused oversight on specific areas, allowing the Board to fulfil its responsibilities effectively whilst ensuring that NUH adheres to its operating license and meets its statutory duties.

The composition of NUH’s Board reflects the need for a balance between strategic oversight, decision-making and seeking assurance with clear distinction between the roles of NEDs and Executive Directors:

• NEDs: NEDs and Associate NEDs (who are non-voting) bring independent judgment and expertise to the Board. They challenge, scrutinise, and support the Executive Directors while ensuring the Board remains focused on the public interest and the delivery of safe and high-quality services. NEDs and Associate NEDs play a key role in ensuring that the Trust acts in accordance with its values and priorities, maintaining accountability to the public and other stakeholders.
• Executive Directors: Executive Directors are responsible for the day-to-day management and operational performance of the Trust. They are accountable for delivering the strategic objectives set by the Board and ensuring that the Trust’s services are safe, effective, and aligned with patient needs. The Executive Directors include both voting and non-voting members:
  • Voting Executive Directors: These include the Chief Executive and other senior executives responsible for major functional areas (e.g., finance, medical and nursing). They are responsible for implementing the Board’s strategic decisions.
  • Non-Voting Executive Directors: These members provide expertise and advice on specific operational issues but do not have decision-making power in Board votes. They typically hold specialist roles in areas such as strategy or governance.

NUH operates under a Unitary Board Model, which means that the Trust Board is collectively responsible for both the governance and operational leadership of the Trust. The unitary board ensures that there is a cohesive approach to strategy, performance, and accountability, with both NEDs and Executive Directors working together to deliver the Trust's objectives and uphold the standards of care.

The TLT is accountable to the Chief Executive, who—along with the responsible Executive Directors and Care Group Clinical Director is required to provide assurance to the Trust Board that operational activities are coordinated and prioritised in alignment with the Trust’s objectives and the Annual Plan.

The TLT serves as the mechanism through which the Chief Executive (CEO) makes decisions that fall outside the remit of the Trust Board or its Committees, in accordance with the Trust’s Scheme of Delegation.

The statutory Executive Directors of the Board, which include the Chief Executive and key Directors responsible for statutory functions (such as finance, medical, and nursing), hold specific responsibilities as outlined by law and regulation. These responsibilities ensure the Trust meets its legal obligations, such as compliance with the Care Quality Commission (CQC) standards and financial regulations. A more detailed description of these statutory responsibilities is provided in the Appendix 2 of this document.

NUH is committed to upholding the Nolan Principles of Public Life, which form the ethical foundation of our governance and accountability structures. These principles guide the conduct of the Trust Board and all staff, ensuring that decisions are made with integrity, transparency, and accountability. The Nolan Principles of Public Life are:

• Selflessness
• Integrity
• Objectivity
• Accountability
• Transparency
• Honesty
• Leadership

There are a number of official organisations set up by law to regulate various aspects of the NHS in the UK, these are listed in appendix 3.