NHS Tayside Transformation Support Team: report

Introduction

On 27 June 2017, the NHS Tayside Assurance and Advisory Group ( AAG) submitted their Staging Report ^[1] on the robustness of NHS Tayside's financial projections and recovery plans to Paul Gray, Director General of Health and Social Care and Chief Executive of NHS Scotland.

As a result of the findings and the 10 recommendations for NHS Tayside, Paul Gray asked me to lead a Transformation Support Team ( TST) to work alongside NHS Tayside to provide help and support to implement the recommendations. The other members of the TST are:

• Barbara Anne Nelson - Interim Director of Workforce, NHS Fife
• Professor Alex McMahon – Executive Director, Nursing, Midwifery and Allied Healthcare Professionals, NHS Lothian

Alan Gray, Director of Finance, NHS Grampian, was a member of the TST up until early September when he withdrew from the group in order to take up a new role as Strategic Finance Lead for the North, which includes provision of strategic support for NHS Tayside.

The team is also being supported by Alpana Mair and Simon Hurding from the Effective Prescribing and Therapeutics Team in the Scottish Government.

The recommendations of the AAG report are designed to deliver an immediate improvement in the in-year financial position of the Board (Recommendation 1) and also to address issues of longer term sustainability through significant transformational service change (Recommendation 3). Delivery of recommendations 2, 4 and 6 are fundamental to being able to model that transformational service change and to be assured that it will deliver sustainable quality services. Recommendation 5 is essential to both the short term and the longer term financial position of the Board. This understanding is reflected in the diagram on the next page.

Recommendations 7 to 10 are important as enablers of the work that will need to be done to deliver short and long term changes and to ensure that the totality of the endeavour is appropriately led and managed.

In its programme of work, the TST has sought to ensure that the Board retains an urgency of focus on the short term financial position while at the same time developing the processes and approach that will deliver the transformational change required for long term sustainability of quality services. We have been very conscious of the dependencies intrinsic in the relationship between the recommendations.

TST members have worked with the Executive Directors responsible for the delivery of the recommendations and provided advice and support to them, as well as acting as a critical friend to challenge the appropriateness of the action being taken. This has involved commenting on draft Board papers, attending meetings, liaising with stakeholders and sharing professional experiences. The TST worked with NHS Tayside to produce an action tracker to facilitate monitoring of actions designed to deliver the AAG recommendations. As part of this work we described the outcomes that we expected the recommendations to deliver and the impact that achieving the recommendations would have. We also sought to set out some high level measures. This proved challenging in some areas which are noted in this report.

The purpose of this report is to inform the AAG, who have been asked by Paul Gray to report back, at the end of September, on NHS Tayside's progress towards delivering their recommendations. This report is broken down into the 10 recommendations and sets out the TSTs analysis of progress against each. This analysis is based on the evidence the TST has gathered in the last 3 months and from NHS Tayside's own self-assessment which details both the outcomes which are anticipated to arise from the agreed actions along with the work completed to date and evidence to support the Board's assessment of progress. The self-assessment has been a valuable exercise for NHS Tayside to take stock three months in and to reflect on whether the actions identified in the tracker are the right ones to deliver the transformational change required.

As part of the assessment, a Black, Red, Amber or Green ( BRAG) rating was given to each recommendation, based on the definitions below:

• Black – there is no confidence that plans will deliver the anticipated outcomes, or there is a complete lack of a plan for a recommendation.
• Red – significant activity is still required to develop realistic plans that will give confidence that the outcomes will be realised timeously, or substantial activity may have already begun but there is a high level of risk that anticipated results will not be realised.
• Amber – realistic and credible plans are in place to deliver the outcomes but they have not yet been implemented, or have been partially implemented, and results are still to be seen.
• Green – plans are robust with activity already leading to results in line with the anticipated outcomes.

"Our commentary on NHS Tayside's assessment includes key areas where we want to see demonstrable progress by the end of December. We will meet with, and agree a set of metrics with NHS Tayside's Executive Team, to ensure there is clarity in how we will judge whether progress has led to tangible benefits."

Finally, I would like to acknowledge NHS Tayside's Executive Team openness and willingness to fully engage with the TST and their commitment to delivering transformation change.

Caroline Lamb

Chief Executive, NHS Education for Scotland

Chair, NHS Tayside Transformation Support Team