NHS Scotland - blueprint for good governance: second edition

C. The Assurance Information System

C.1 The assurance information system should be designed to provide frequent and informative performance and financial reports to assure the Board that it is delivering safe, effective, patient- centred, affordable and sustainable services. This system should deliver relevant, accurate and timely information on a wide range of activities, including:

• Service delivery
• Safety and quality standards
• Innovation and transformational change
• Workforce
• Education, training and development
• Finance.

C.2 NHS Boards should agree with the NHS Chief Executive the contents of the assurance information system required by the Board and the standing committees. This should include information on both the management of current operations and the progress being made to deliver change across the healthcare system.

C.3 How data should be presented in order to assist those preparing papers for Board Members’ scrutiny should also be agreed with the NHS Chief Executive and in the case of territorial NHS Boards, with the Health and Social Care Partnership’s Chief Officer(s).

C.4 Board papers should show data in a clear, consistent and effective way to ensure that Board Members are able to understand and interpret its significance and receive the level of assurance required. Best practice in presenting data includes:

• Presenting statistical information in charts or tables, rather than in a narrative format
• Including actual numbers rather than percentages, although there will be times where both are appropriate
• Limiting the volume of information shown as charts and tables that have too much information can mean that key messages are lost or difficult to see
• Ensuring units of time are consistent for comparative purposes, e.g., months have variable number of days but weeks always have the same number of days
• Using line charts to measure change or performance over time and if variation is a potential concern, add a target line or convert to a control chart
• Favouring control charts to show if variation is within normal limits and therefore not necessarily a concern
• Describing a position at a point in time by allocating RAG status but these should be used with caution as RAG charts could focus attention on lower priorities
• Benchmarking results using pareto charts which are preferable to pie charts
• Comparing results using funnel charts helps to identify special cause variation, i.e. one not typically expected
• Compiling a whole system view by presenting a series of charts showing different aspects of performance within the same area, giving a more comprehensive and thorough overview
• Including forecasts in tables and charts to describe what results are predicted with the resources available and in the circumstances expected
• Adding trajectories when a changing level of performance over time is required, often by the body commissioning the work.

C.5 Further guidance on the presentation of data to Board Members can be obtained from NHS Education for Scotland’s material on the implementation of the active approach to delivering good governance.

C.6 While data and management information provides Board Members with a particular view of the organisation, to deliver good governance this has to be triangulated with other reports and the more qualitative information available on service delivery.

C.7 Therefore, the assurance information system should incorporate other regular internal reports on the operation of the healthcare system, particularly those that reflect patient, service user and staff experience. Examples of this category of assurance information sources would include the following:

• Healthcare Acquired Infection Report
• Complaints Report
• Duty of Candour Annual Report
• Public Health Screening Programme Annual Report
• Vaccination Programme Annual Report
• Child Poverty Action Plans Progress Report
• Research and Development Annual Report
• iMatter Reports
• Whistleblowing Annual Report.

C.8 It is important that this list is seen as simply an example and the majority of reports included are relevant to territorial Boards. Consideration of these reports by the Board or the appropriate standing committee should form part of the Annual Cycle of Business or in the case of the ad hoc reports, be reviewed at the earliest opportunity.

C.9 The Assurance Information System should also incorporate the wide range of external reports available to Boards. These include one-off Audit Scotland reports on various aspects of the health and social care system, Health Improvement Scotland reviews, Care Opinion feedback, Mental Welfare Commission reports, Scottish Public Services Ombudsman’s reports, NHS Education for Scotland Deanery Reports and the General Medical Council’s reports on the training of junior doctors.

C.10 Board Members should be aware that the specific issues raised in these reports may signal wider concerns. For example, GMC reports on the training of junior doctors can potentially highlight wider issues concerning patient safety and the standard of care, thus providing an opportunity for early intervention and remedial action.

C.11 NHS Boards should also closely scrutinise the reports prepared for the Board’s Annual and Mid- Year Reviews with the Scottish Government and pay particular attention to the Annual Reports submitted to the Scottish Government by the Health and Social Care Partnerships. These documents combine to give a comprehensive account of the progress made by the organisation across both Primary and Secondary Care and should provide Board Members with assurance on the progress being made to deliver the organisation’s purpose, aims, values, corporate objectives, operational priorities and targets.

C.12 In additional to scrutiny of internal and external reports NHS Boards should also pay attention to the feedback to NHS Boards from the Sharing Intelligence for Health and Care Group^[44]. This group is responsible for supporting improvement in the quality of care provided for the people of Scotland and its main objective is to ensure that any potentially serious concerns about a care system are shared and acted upon appropriately. The feedback from the group also highlights examples of where things are working well.

C.13 Feedback from a structured visiting programme by Board Members to frontline services and online discussions with patients, service users and staff should also feature in the assurance information system, enabling the quantitative data and the external perspective to be considered against the Board Members’ impression of the patient and staff’s views of the organisation.

C.14 In addition to having effective strategic planning, risk management and flows of assurance information to the NHS Board, an integrated approach to delivering good governance also relies on having effective internal and external audit arrangements.