Good governance is how a care service knows, rather than hopes, that its care is safe, effective and improving. These five checks give owners, Registered Managers and nominated individuals a practical place to start.

In England, governance is a regulatory requirement. Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires providers to operate effective systems to assess, monitor and improve the quality and safety of their services, manage risks, and maintain secure, accurate and up-to-date records. These systems should be regularly reviewed to ensure they remain effective and support continuous improvement.

Many services already have governance tools in place: policies, audits, incident logs and training matrices. The important question is whether these tools are current, connected and genuinely used to inform decisions. Each check below includes questions you can ask about your own service.

1. Is it clear who is accountable, and does information reach the right people?

Governance starts with leaders who understand what is happening in their service and can demonstrate how they respond. A clear structure on paper means little if important information never reaches the people responsible for decisions.

In smaller services, the owner, nominated individual and Registered Manager may carry several responsibilities between them. In larger organisations, information can become diluted as it passes through different reporting levels. Either way, leaders need reliable information to make informed decisions.

Questions to ask:

• Can senior staff explain their governance responsibilities and how they fulfil them?
• Are governance or quality meetings held regularly, with decisions and actions documented and followed up?
• Do the appropriate leaders receive a consistent overview of incidents, complaints, audit findings, staffing and training?
• When a risk is escalated, is there a record of the decision, who is responsible and what happens next?

What good looks like: A regular quality report that leaders actively discuss, with actions assigned, tracked to completion and reviewed to establish whether the intended improvement has been achieved.

2. Are your policies current, and do staff understand how to apply them?

A policy is useful only when it reflects relevant requirements and supports safe practice. Outdated or generic policies can create a gap between what a service says should happen and what staff actually do.

Policies should be reviewed in line with relevant legal and regulatory requirements, current guidance, the service’s own review arrangements and any changes in practice.

Questions to ask:

• Does each policy have an identified owner, review date and version history?
• Are any policies overdue for review or in need of updating?
• Have relevant changes in guidance, legislation or the service’s operating model been considered?
• If you asked staff how they would respond to a medication error or safeguarding concern, could they explain the appropriate process?
• How are policy changes communicated, and how do you check that staff understand them?

What good looks like: A maintained policy register, supported by supervision, training and appropriate checks that help establish whether staff understand and follow the procedures relevant to their roles.

3. Do your audits identify issues, and are improvements followed through?

An audit programme is useful when it helps identify gaps, prompts appropriate action and provides evidence that improvements have been effective. Regulation 17 requires effective assurance and auditing systems that support ongoing evaluation and improvement.

Consistently perfect audit scores are not necessarily a problem, but they can be a reason to check whether the audit tools are sufficiently robust and whether findings are being independently challenged where appropriate.

Questions to ask:

• Is there an audit schedule covering relevant areas such as medicines, care plans, records and infection prevention and control?
• Are audits completed by appropriately trained people, with independent or peer checks where useful?
• Does each finding lead to an action plan with a named owner and deadline?
• Can you demonstrate that an identified issue was addressed and that a subsequent review checked whether the improvement was effective?

What good looks like: A central action log that brings together audit findings, assigns responsibility and tracks progress. Completed actions are supported by evidence, rather than simply marked as closed.

4. Are you learning from incidents, complaints and feedback?

Incidents, safeguarding concerns, complaints and feedback can provide valuable information about the quality and safety of a service. Effective governance involves reviewing this information, identifying themes and using the findings to improve care.

The number of reported incidents alone does not establish whether a service is safe. Leaders should consider the nature of incidents, the quality of reporting, emerging patterns and whether concerns are addressed appropriately.

Questions to ask:

• Are incidents, safeguarding concerns and complaints recorded and reviewed in a way that makes patterns easier to identify?
• Are recurring themes examined, such as falls at particular times or repeated medication issues?
• Are incidents, safeguarding concerns and other notifiable events reported to CQC or referred to the relevant local authority when required, and within the applicable timescales?
• How is learning shared with staff and, where appropriate, people receiving care and their families?
• Do you actively seek feedback, and can you show how it has influenced decisions or improvements?

What good looks like: A regular review of themes and actions, with clear examples of how feedback and concerns have led to changes in practice.

5. Can you demonstrate staff competence, not just training completion?

A training matrix can show who has attended a course, but attendance alone does not always demonstrate competence. Providers need appropriate ways to establish whether staff can carry out their responsibilities safely and effectively.

Depending on the role and task, this may include observation, supervision, competency assessments and reflective discussions, particularly for higher-risk activities such as medicines support, moving and handling or clinical procedures.

Questions to ask:

• Does your training matrix identify overdue or expiring training, and is there a process for addressing gaps?
• Where appropriate, are higher-risk tasks supported by documented competency assessments as well as training records?
• Are supervision and appraisal arrangements being followed in line with the service’s policies and applicable requirements?
• Are recruitment records complete, including references and appropriate DBS checks where required?
• Are records relating to people receiving care and staff accurate, complete, up to date and stored securely?

What good looks like: A training and competency overview that leaders review alongside supervision and other relevant checks, with gaps addressed and actions documented.

Bringing it together

These five checks are connected. Accountable leaders need reliable information, supported by current policies, meaningful audits, a culture of learning and a competent workforce. Weaknesses in one area can reveal opportunities to strengthen others.

You do not need to address everything at once. Start with the area where your service has the greatest uncertainty, review the available evidence and agree on a small number of practical actions with named owners and timescales.

If you would value an independent perspective, Willow Clinical & Care Consultancy offers nurse-led governance support for care providers in England. Explore Willow’s Governance & CQC support or get in touch to discuss your service’s needs.

This article provides general information and is not legal or regulatory advice. Requirements can vary according to the service and circumstances. Always consult current CQC guidance and other applicable requirements.

Sources

• Care Quality Commission: Regulation 17 — Good governance: https://www.cqc.org.uk/guidance-providers/regulations/regulation-17-good-governance
• Care Quality Commission: Good governance of medicines: https://www.cqc.org.uk/guidance-providers/adult-social-care/good-governance-medicines
• Care Quality Commission: Medicines administration records in adult social care: https://www.cqc.org.uk/guidance-providers/adult-social-care/medicines-administration-records-adult-social-care
• Care Quality Commission: Regulations for service providers and managers: https://www.cqc.org.uk/guidance-regulation/regulations-service-providers-and-managers