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1/12 Important Kark Review published yesterday. Our view, drawn from this briefing: nhsproviders.org/resource-libra…. This is complex and difficult territory and it's vital that @MattHancock, @DHSCgovuk and @NHSImprovement proceed carefully, taking time to really listen to provider views! 
2/12 Kark Review: difficult but vital to get right balance between ensuring that the vast majority of effective boards and directors have appropriate autonomy to do their job and intervening to prevent/regulate what are a very small number of serious failures. Complex stuff!
3/12 Kark: vital to understand that the key principle behind trust level governance is that unitary trust board is responsible for everything that happens within the trust. This clarity is essential given the amount of risk at trust level - for example clinical and safety risk.
4/12 Kark: the ability of trusts to appoint & oversee the conduct of their directors is a fundamental element of their responsibility/accountability for everything that happens within their trust. So, however well intentioned, we need to be really careful if we cut across this.
5/12 Kark: recommendations are wide ranging and far reaching. Disappointing and regrettable that @DHSCgovuk has chosen to accept some of them without the proper consultation they needed and deserved. Not the right way to make policy in this important space, in our view.
6/12 Kark: some recommendations remitted to @didoharding to consider and she will also look at implementation of proposals @DHSCgovuk has already accepted. Vital that she sets up a proper process to fully consult providers on all of this.
7/12 Kark: @NHSProviders engaged extensively with members and review itself and we know that members will have concerns with what's proposed - see below. We recognise lots of people feel strongly about these issues, with good reason, but policy make in haste, repent at leisure.
8/12 Kark: if we are to have a central database of Directors, how do we ensure that the compliance burden is proportionate and reasonable given that, in Kark's own words, the vast majority of Directors are doing an outstanding job?
9/12 Kark: how do we create a meaningful set of core competences and associated assessment process for NHS trust Directors when so much of being an effective board director is about judgement, behaviour and cultural approach, not measurable knowledge?
10/12 Kark: how do you create a robust, meaningful, universally applicable definition of "serious misconduct" given how notoriously difficult this has been in the past and when may of the areas Kark suggests it covers are not amenable to black and white judgement?
11/12 Kark: do we need a new Health Directors Standards Council and if one is created how will it work - for example ensuring appropriate right of appeal and how it interacts wth trusts' duties and responsibilities as an employer? Complex stuff we can't afford to get wrong.
12/12 Kark: vital to understand that quality of trust governance, and therefore quality of services, depends on trust's ability to attract right quality of Directors. Good people make a judgement on balance of risk involved before applying. We mustn't forget this!
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