NHS Forth Valley Assurance Board: terms of reference

Authority

The Assurance Board for Governance, Leadership and Culture, NHS Forth Valley (hereinafter, “the Board”) is convened at the request of the Scottish Government Director General for Health and Social Care and Chief Executive of NHS Scotland, further to their letter of 23 November 2022 to the Chair and Chief Executive of NHS Forth Valley. 
These terms of reference have been set by the Director General, further to consultation with the members of the Board.

Purpose and role of the Assurance Board

The purpose of the Board is: 

• to support NHS Forth Valley in determining what steps are necessary to ensure the delivery of high quality governance, leadership and culture in NHS Forth Valley, and in doing so support improvements in performance in out of hours, unscheduled care, mental health, and integration and 
• to advise the Director General through agreed governance routes that such steps have been taken

In delivery of this, the Board will seek to:

• ensure appropriate governance is in place, particularly with regards to providing appropriate scrutiny of performance, leadership style and practice
• scrutinise the NHS Forth Valley Improvement Plan and through assurance meetings hold the leadership (i.e. NHS Forth Valley Executive Leadership Team and Chair of the NHS Forth Valley Board) to account for the effective delivery of these improvement actions and within the timescales agreed
• ensure that the leadership is operating in an effective and inclusive manner, particularly when understanding and managing performance issues, and that there is a positive and inclusive culture in NHS Forth Valley
• consider the lessons learned that could be shared across NHS Scotland and
• provide advice to the Director General about the future escalation status of NHS Forth Valley, including criteria for de-escalation

Background

Concerns have been raised in relation to a range of performance-related issues, including concerns around GP out-of-hours services, unscheduled care, mental health and integration. Whilst poor performance in any discrete area is of concern, effective governance, strong leadership and improved culture is required to deliver sustainable change. 

Stage 4 escalation came into effect from Wednesday 23 November, and brings direct formal oversight and coordinated engagement from Scottish Government (SG) in the form of the Assurance Board, chaired by Christine McLaughlin, Director of Population Health. 

Approach

As part of the standard sponsorship relationship, SG sets objectives and priorities for the NHS, signs delivery plans with each NHS Board, monitors performance, and supports Boards to ensure achievement of these key objectives. 

The Assurance Board is carrying out this function solely in relation to NHS Forth Valley’s escalation for governance, leadership and culture. The Assurance Board will provide direct monitoring and support to NHS Forth Valley but the onus is on the NHS Board to commit to, and deliver on, improvement.

The Assurance Board will agree a programme of work to pursue the objectives described above (section four). In doing so, it may establish sub-groups with necessary experts and other participants.

The remit of the sub-groups will be set by the Chair of the Assurance Board, in consultation with Board members. The Board will receive reports and consider recommendations from the sub-groups.

In line with the NHS Scotland escalation process, NHS Forth Valley will work with the Assurance Board to develop an Improvement Plan and to take responsibility for delivery. The NHS Forth Valley Chief Executive as Accountable Officer continues to be responsible for matters of resource allocation connected to delivering actions agreed by the Assurance Board.

The Assurance Board works separately to the NHS Forth Valley Board and does not form part of internal governance structures within NHS Forth Valley. 

The Board will ensure all work is conducted in a way that supports the values of Scottish Government and NHS Scotland.

The work of the Board will also be informed by engagement work undertaken with other stakeholder groups as required, in particular NHS Forth Valley staff.

The Board is focused on improvement. Board members, and sub-group members, will ensure a lessons-learned approach underpins their work in order that learning is captured and shared locally and nationally.

Meetings

The Board will meet fortnightly initially and will thereafter determine an appropriate schedule of meetings. 

Secretariat support will be provided by officials from the Office of the Chief Operating Officer, NHS Scotland. 

The circulation list for meeting details/agendas/papers/action notes will comprise Board members and relevant officials from the office of the Chief Operating Officer. 

The Chair and Chief Executive of NHS Forth Valley will also receive copies of the papers.

Regular reports will also be provided to the National Oversight for Performance and Planning Group (NPPOG). 

Objectives, deliverables and milestones

The objectives for the Assurance Board are to:

• provide scrutiny and challenge to the NHS Forth Valley leadership team as they take forward action to improve governance, leadership and culture at NHS Forth Valley and 
• to hold the leadership team of NHS Forth Valley to account for the development and delivery of an NHS Forth Valley Improvement Plan

Matters that are not related to the issues that gave rise to escalation are assumed not to be in scope, unless the work of the Board establishes a significant link to these issues.

In order to meet these objectives, the Board will retrospectively assess issues around the governance, leadership and culture which have given rise to performance issues around GP out-of-hours services, unscheduled care, mental health and integration.

Having identified these issues, they will develop and produce a gap analysis and work with NHS Forth Valley to seek assurance that they have already been resolved or that action is being taken to resolve them; compare systems, processes and governance with national standards; and make recommendations for improvement and how to share lessons learned across NHS Scotland. 

The issues will be assessed with regards to the information available at the particular point in time and relevant standards that were extant at that point in time. 

Consideration will also be given to any subsequent information or knowledge gained from further investigations and the lessons learned reported.

Governance

The Assurance Board will be chaired by Christine McLaughlin, Director of Population Health, and will report to the Director General for Health and Social Care and to NPPOG.

• Christine McLaughlin, Co-Director of Population Health, Scottish Government (Chair)
• Gregor Smith, Chief Medical Officer, Scottish Government
• Alex McMahon, Chief Nursing Officer, Scottish Government
• Gillian Russell, Director of Health Workforce, Scottish Government
• Angie Wood, Director of Social Care Resilience, Scottish Government
• Richard Foggo, Co-Director of Population Health, Scottish Government 
• David Miller, Chief People Officer, Scottish Government
• Robert Kirkwood, Head of the Office of Chief Executive, Scottish Government
• Tracy Slater, Head of Performance and Delivery, Scottish Government 

Members are not permitted to send deputies to the Assurance Board. 

In addition to these members, the Chair may request the attendance of other attendees at meetings based on agenda items. 

External support to NHS Forth Valley 

SG external support team

• Professor Hazel Borland, Professional Advisor, Chief Operating Officer, Scottish Government. Previously Nurse Director/Deputy Chief Executive and interim Chief Executive NHS Ayrshire and Arran
• Dr John Harden, Deputy National Clinical Director, Scottish Government. Consultant, Emergency Medicine, NHS Lanarkshire
• Prof John Brown, Chair of NHS Greater Glasgow and Clyde 

Purpose

• lead and co-ordinate senior level external support to the Board
• work jointly with Scottish Government Directors, HIS and other delivery partners to support the FV Senior Leadership Team to deliver the required improvements
• support and advise NHS Forth Valley in the development and delivery of a coordinated improvement plan across affected service areas which focusses on leadership, culture and governance
• support, advise and mentor the Executive Leadership Team (ELT) across the breadth of their portfolios in order to support delivery of the improvement plan
• build relationships and develop an understanding of the current landscape of interactions between CEO, Chair and senior leadership team
• identify any gaps in the improvement plan and ensure these are addressed
• provide constructive and compassionate scrutiny, challenge and feedback to the NHS Forth Valley Senior Leadership Team and Chair
• feedback to NHS Forth Valley Senior Leadership Team and Chair with regard to progress
• report progress, concerns, assurance to the Assurance Board
• support the establishment of systems and processes to maintain and sustain improvements made through this overall approach

This will be achieved by: 

• building relationships with:
  • medical and Nurse Directors and their teams in particular in terms of patient safety and quality of care
  • CEO and wider director team
  • staff side colleagues 
  • other key stakeholders
• observational interventions
• specifically supporting and mentoring the Medical and Nurse Directors with regard to their portfolios, including quality of care and patient safety
• staff engagement, including staff side colleagues
• working closely with HIS QI expertise to support delivery of focussed improvement interventions
• a regular meeting structure of:
  • weekly improvement support team meeting
  • weekly meeting with Medical and Nurse Directors (both together and separately as required)
  • weekly meeting with CEO, Medical and Nurse Directors

Reporting mechanisms

• weekly/fortnightly (as required) discussion with Assurance Board Chair
• fortnightly report to each Assurance Board meeting
• regular feedback to NHS Senior Leadership Team as required

Healthcare Improvement Scotland (HIS) have also been commissioned by NHS Forth Valley to provide tailored support to deliver on the actions and recommendations following recent HIS safe delivery of care inspections. 

Prof John Brown, Chair of NHS Greater Glasgow and Clyde, will provide support to the Chair of NHS Forth Valley and will undertake a full independent review of Board and Assurance Committee governance arrangements in NHS Forth Valley, in line with the Blueprint for Good Governance and other best practice. This work will begin in early January. 

Stakeholders

The Assurance Board recognises that a broad range of stakeholder groups have an interest in their work, and will seek to ensure their views are represented and considered. 

In particular the Assurance Board will work with The Board, Senior Leadership and staff of NHS Forth Valley, the Integrated Joint Boards and the three Local Authorities in the area of NHS Forth Valley, Falkirk, Clackmannanshire and Stirling Councils.