Independent Oversight and Assurance Group on Tayside's Mental Health Services

Governance Work Plan

Recommendation 6

Ensure that Board Members (NHS and Integration Joint Boards) are clear about their responsibilities, confident and empowered to challenge and make sound decisions. Review their selection, induction and training processes in preparation for their important role.

Context of Oversight Group assessment: Clarity of roles and responsibilities at Board level is an important part of providing clear direction for the organisations involved in delivering mental health and learning disability services in Tayside.

305. We have been keen to explore the cultural and behavioural aspects of this recommendation, as well as the more technical issues. We have attended meetings of the three Integration Joint Boards, Health Board meetings and several Standing Committees of NHS Tayside. In addition, we have conducted a high-level analysis of Health Board business.

306. As outlined in our integration work plan, we are assured that the clarity of roles and responsibilities between the Integration Joint Boards and the Health Board is now in a better place, following the revision of the integration schemes. This provides an important foundation for Board Members as they carry out their important scrutiny and leadership role.

307. Since the Trust and Respect report was published, there has been significant changes in membership across the four Boards (NHS Tayside and the three Integration Joint Boards). NHS Tayside has recruited eight new Non-Executive Members in 2022, from a range of backgrounds, including some with experience of mental health services. This provides a good opportunity to bring in new skills and experience and the induction process appears to have been sound.

308. Such a high intake of new Board Members can also introduce some risk, and it will be important for the Board to ensure that Members continue to be supported in their development as they grapple with their important and wide ranging roles.

309. Similarly, Integration Joint Boards have also experienced a degree of change in membership, partly as a result of new appointments in the NHS and partly due to the local government elections in 2022. Again, induction and development will be important for the new Members, particularly to ensure that Integration Joint Board Members fully understand the new integration schemes. We have been encouraged by how the Integration Joint Boards have responded to our engagement with them so far and have taken on board our feedback.

310. Our meetings with Board members have suggested that they feel confident and empowered to carry out their roles. We have, however, at times observed a reluctance to challenge senior officers, suggesting that there remains more work to be done here. We cover this more it the next recommendation.

311. We welcome the new appointments across the Boards and believe this provides a strong foundation for continued improvement. The Oversight Group's assessment is therefore Green.

Recommendation 7

Provide sufficient information to enable board members to monitor the implementation of board decisions.

Context of Oversight Group assessment: While the original recommendation was quite narrowly drawn, we have been interested to understand more broadly the information received by Boards to enable them to carry out their leadership and scrutiny role in general, and in mental health and disability services more specifically.

312. We acknowledge that Boards operate in a wider governance landscape. In the NHS, for example, there are a number of committees where we would reasonably expect a lot of the detailed work to be undertaken, before being considered at the Board. We acknowledge that Boards operate in a wider governance landscape. In the NHS, for example, there are a number of committees where we would reasonably expect a lot of the detailed work to be undertaken, before being considered at the Board. The NHS Board operates a system of internal controls which means that assurance is often already provided by the time it reaches the Board.

313. That said, it is clearly important that Boards do more than simply 'rubber stamp' work that has happened elsewhere. This is particularly important in the context of public scrutiny and accountability – the NHS Board and the Integration Joint Boards are public forums which should provide a degree of assurance to the people of Tayside that these crucial public services are well governed and well led.

314. It is also the case that a lot of what we have observed in Tayside will exist to varying degrees across the country. For example, the challenges of governance in Integration Joint Boards are well documented and are subject to review as part of the programme to establish a National Care Service.

315. Having undertaken a high-level analysis of Board papers for both NHS Tayside and the three Integration Joint Boards, we would make the following general observations about governance and the operation of the Boards:

• Members are, on the whole, well prepared and committed to carrying out their role diligently. It is important to recognise the valuable public service that Board Members are undertaking.
• In process terms, the papers of the public NHS Board meetings do not seem to be made publicly available until very shortly before – and in some cases after – the meeting has started. It is important for public scrutiny that members of the public are able to see the public papers in good time.
• The majority of papers across the Boards are for noting – the Integration Joint Boards give very few Directions and the NHS Board doesn't seem to make many decisions.
• Agendas are very full and the sheer volume of papers that Board Members need to digest make detailed scrutiny challenging in the time available. We were struck at times by the lack of discussion and challenge on some important agenda items, for example the revised integration schemes at the NHS Tayside Board.
• At times, we observed a reluctance of Non-Executive Board Members and Councillors (on Integration Joint Boards) to challenge or scrutinise senior officers. This is a tricky balance to get right - Board Members are clearly there to lead and support too. But, officers could perhaps do more to write papers and behave in ways that actively encourage scrutiny and challenge.
• More specifically in relation to our work, we believe that performance information related to mental and learning disability services could be more clearly presented to encourage greater scrutiny and discussion.
• Finally, we have been surprised that the Boards have not received, nor asked for, a comprehensive update on Listen, Learn, Change since June 2021. While there are narrative updates provided, it is hard to see how the Boards can have a clear picture of progress overall. We have also noted that our quarterly progress reports have not been considered routinely by the Boards. This has consequences for the public scrutiny of progress against the Trust and Respect recommendations.

316. As we said in response to the previous recommendation, we welcome the appointments of new members, and this provides a good opportunity for continued improvement to governance and scrutiny. But our work has demonstrated areas where more needs to be done and, for this reason, the Oversight Group's assessment remains Amber.

Recommendation 9

Clarify responsibility for the management of risks within NHS Tayside and the Integration Joint Boards, at both a strategic and operational level.

Context of Oversight Group assessment: This recommendation is clearly linked to our work on the integration work plan.

317. It is our view that the revised integration schemes bring more clarity to roles and responsibilities across Tayside for mental health and learning disability services. In addition, we welcome the improved partnership working demonstrated by the Integrated Leadership Group.

318. We have seen evidence that this clarity and improved partnership working extends to the identification and management of risks. In particular, the greater clarity around the lead role of Perth and Kinross Integration Joint Board in relation to mental health and learning disability services, means the management of strategic risks are now more clearly defined.

319. Given the relative newness of the revised schemes, we recognise that more needs to be done to embed strategic and operational risk management across the system in Tayside. Nonetheless, we believe that the work undertaken to date provides sufficient assurance for the Oversight Group to assess this recommendation as Green.