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Strengthening board decision-making through risk and governance

As the NHS embarks on a decade of transformation, boards are navigating increasing complexity across workforce, finance, procurement, digital and population health.

15/07/2026 · 5 minute read

As the NHS embarks on a decade of transformation, boards are navigating increasing complexity across workforce, finance, procurement, digital and population health. At the NHS Confed Expo, Marsh convened a panel of NHS leaders and experts to explore how an integrated approach to risk and governance can help leaders make forward-looking, evidence-led decisions that support sustainable change.  

The NHS 10-Year-Plan set out a bold vision for the future of healthcare, the three big shifts: from hospital to community, analogue to digital, and sickness to prevention while facing unprecedented levels of patient demand. Leaders are working to redesign care and improve outcomes for patients against a backdrop of financial pressure, workforce challenges, changing population needs and rapid technological advancement.

Much of the leadership conversation is, unsurprisingly, focused on delivering the transformation. However it’s equally important to consider the role of governance in supporting organisations navigate change. Effective governance helps boards manage complexity, prioritise, and make confident, evidence-led decisions.  

At the recent NHS Confed Expo, Marsh convened a panel of industry experts to explore what a fresh approach to board risk and governance might look like. Panel members included Sarah Triggs, Health and Social Care Industries Leader, Marsh UK, Mark Riley-Pitt, Strategic Healthcare Risk Consulting Leader, Marsh UK, Sir David Sloman, Former COO NHSE and NHS London Director, and Joe Rafferty CBE, Chair of The Christie and former CEO of Mersey Care FT.  

You can watch the full playback of the panel discussion here

Throughout the conversation, it was clear that risk should not be viewed as a standalone governance exercise. Instead, it provides a unifying lens through which boards understand the relationships between workforce, finance, operational performance, digital transformation and population health.   

The conversation explored three key questions:

As healthcare becomes increasingly interconnected, so too do the risks that boards oversee. While workforce, operations, finance and patient safety are often viewed in silos, they are closely linked. It’s well known that a decision in one area can have consequences elsewhere, creating a ripple effect across the wider system.  

Today’s challenge is recognising how risks interact and the trade-offs they create - essential in ever increasingly complex healthcare systems. 

  • What happens if action is delayed? 
  • Where might investment in one area reduce pressure elsewhere? 
  • What’s the cost of doing nothing?   

In procurement, for instance, supplier risk is ultimately a patient safety risk, not simply a commercial issue. Looking beyond immediate suppliers can reveal dependencies in the wider supply chain that might otherwise remain hidden but have implications for service continuity and patient care. More broadly, this highlights the value of integrated thinking and understanding risk in the round.   

One of the most thought-provoking points raised was the distinction between being informed and being assured. There’s no shortage of data within the NHS, but of course information alone does not provide assurance. True assurance comes from understanding how risks overlap, recognising cross-domain signals and pinpointing what these might be telling us about the future.  

Emerging risks often become visible only when workforce, operational, safety and financial data are considered together. Rising sickness absences, declining staff engagement and increased incident reporting, for example, may collectively point to wider concerns around workforce capacity, wellbeing or psychosocial safety.  
 
This requires a different way of scrutinising information - one that helps boards distinguish between the issues that need monitoring and those needing intervention.   

Rather than relying on retrospective reports, boards have an opportunity to join up indicators from across the organisation, consider trends over time, then ask deeper questions.   

  • Why hasn’t this improved? 
  • What are we missing? 
  • Does our current reporting provide sufficient visibility of the future?   

Predictive analytics and AI tools can be hugely valuable here. They can help boards look beyond current performance and develop a clearer view of future demand, particularly as changing demographics and population health reshape workforce and skills requirements.  

There’s always tension between immediate pressures and longer-term thinking. Take workforce planning, for example - training a nurse or specialist clinician takes years, but many decisions are still shaped by annual cycles. Making room for longer-term planning alongside operational oversight helps boards build a stronger evidence base for decisions about the future workforce. It also prompts the question: what will the population need in five, ten, or even twenty years’ time? Easier said than done but protecting time for these conversations helps prevent longer-term risks from being crowded out by immediate challenges. Advanced population health tools are a gamechanger from a time and focus perspective. 

Long-term transformation also depends on organisations’ ability to learn and adapt. Encouragingly, many are already embracing this mindset. Trusts embedding a just culture and promoting psychological safety are creating environments where people feel empowered to speak up, so concerns are identified, escalated and addressed earlier, and learning is valued. In turn, boards gain earlier visibility of future risks. 

A pivotal moment for governance

The ambitions of the NHS 10-year-plan are considerable, but so is the opportunity.   

Confed resonated with optimism to rise to the challenges ahead. There are some great examples of organisations taking a more joined-up and strategic approach to risk. Continuing to build on these learnings will help boards anticipate challenges, make confident, evidence-based decisions and support the next chapter of NHS transformation - ultimately safeguarding it for future generations.  

If you’d like to explore how your organisation can take a more connected approach to risk, governance and board assurance, our healthcare specialists would be pleased to speak with you.

Our people

Sarah Triggs

Health and Social Care Industries Leader, Marsh UK

  • United Kingdom

Mark Riley-Pitt

Strategic Healthcare Risk Consulting Leader, Marsh UK

  • United Kingdom

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