An efficient and effective Board Assurance Framework (BAF) is a fundamental component of good governance, providing a tool for the Board to identify and ensure that there is sufficient, continuous and reliable assurance, organisational stewardship and the management of the major risks to organisational success.

The principles of assurance frameworks have been in place for decades, and there has been a continued focus on ensuring the embeddedness of these processes and the extent they are used by the Board.
Throughout its history the NHS has faced numerous risks and recent years have been no different. However, the context of these risks has changed with an increased emphasis on system working in a financially constrained environment.

Whilst traditionally the BAF focused on risks, controls and assurances within the organisation, we are starting to see a wider focus across organisation boundaries and an increase in external risks to reflect the environment within which organisations are operating.

Review of BAFs across MIAA’s NHS client base for 2023/24 and 2024/25 identified a number of risk themes spanning estates, financial stability, quality of care, workforce, partnerships, digital infrastructure, research, environmental sustainability, service quality, safety, and more.

This insight provides a detailed overview of the risk themes identified each year, highlights trends between the two years, and offers predictions for the rest of 2025 and beyond based on these trends.

Download the full Insight