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.

Review of BAFs across MIAA’s NHS client base for 2023/24 to 2025/26 identified a number of risk themes. The NHS principal strategic BAF risks have continued to evolve between 2023/24 and 2025/26, reflecting changes in the operating environment, strategic priorities, and emerging challenges.

Whilst People, Quality & Safety, and Financial Sustainability have remained consistent areas of strategic focus, their relative priority has shifted over time in response to organisational needs and external pressures. The prominence of Strategic Direction & Partnerships in 2024 reflected an increased focus on system working, collaboration, and organisational transformation, whilst Quality & Safety emerged as the highest ranked strategic risk in 2025, highlighting the continued importance of delivering safe, effective, and high-quality care. 

The introduction of Digital as a top five principal strategic risk in 2025/26 demonstrates the growing significance of digital transformation, technology, data, and cyber resilience in supporting service delivery and achieving strategic objectives.

Reviewing the evolution of these risks provides an opportunity to understand how the NHS risk profile has changed over time and to ensure the BAF remains aligned to organisations’ strategic objectives, risk appetite, and future priorities.

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