As specialists in company compliance and corporate governance, London Registrars ( understands that there can often be a gap between best practice in theory and the practical reality of running an organisation. Research published earlier this year in The ICSA Chartered Secretary Magazine revealed that this is indeed the case within the NHS; that NHS boards are failing in key areas of corporate governance.

The ICSA research project, the results of which were published in the magazine in August of this year, was called ‘Mapping the Gap’ and involved analysing 1,277 board agendas and carrying out 176 questionnaires and interviews with participating NHS board members. ICSA identified four key areas of corporate governance as the focus of this research: strategy; decision-making; clinical and quality matters; and probity and transparency. The principal findings of the study which pointed to a significant gap between best practice in theory and in reality were:

  • 10 per cent of agenda items were regarding strategy, markedly failing the best practice recommendations of 60 per cent;
  • Just 5 per cent of NHS boards aligned clinical and quality issues to strategic objectives;
  • Board members were more frequently issued with items to note than asked for concrete decisions;
  • Just 75 per cent of board agendas included items which were declarations of interest;
  • Clinical and quality issues took up between 4 and 13 per cent of the top five agenda items, failing to reach the governance guidelines of a minimum of 20 per cent;
  • 1 per cent of those surveyed in the questionnaires agreed that a priority for the board was involving the public in shaping NHS healthcare services.

Seamus Gillen, Director of Policy at ICSA, stated in the magazine that “Good practice governance allows NHS Trusts to be efficient, effective, and accountable. It underpins everything. These findings illustrate that there is a gap between good practice and what happens in reality. We need far more emphasis on strategy and effective decision-making if NHS boards are to achieve their objectives in an increasingly fluid environment”.

With the expert assistance of corporate and legal support firm London Registrars, organisations can ensure that they are meeting best practice targets in corporate governance. Find out more at