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Publication - Progress report

NHS Tayside Assurance and Advisory Group: third progress report

Published
13 December 2018
Directorate
Health and Social Care Finance Directorate
Topic
Health and social care
ISBN
9781787814547

The report was authored by Sir Lewis Ritchie and Caroline Lamb.

View supporting documents Supporting documents

Annex D: Scottish Government Response to AAG Recommendation 14

As noted in the previous Progress Report, published in January 2018, key workstreams in respect of Recommendation 14 involved:

  • Documentation of the learning from NHS Tayside to aid informing the development of a Performance Framework; and
  • The development of an NHS Scotland Framework which sets out an approach to sustainable performance improvement and value across the Health system

Since our last update, resource has been identified and deployed in the Organisational Sustainability and Value (OSV) team of the Health and Social Care Directorates to progress the development and implementation of this Framework. Key workstreams underway involve:

  • Understanding the current practices and policies for engaging with Boards on financial and operational performance and the current toolkit of interventions (both formal and informal);
  • Performing a gap analysis between current and best practice in terms of expectations of a health system performance framework;
  • Based on the above two phases of work, defining key assessment criteria, triggers for escalation and a toolkit of interventions for each stage of the Performance Framework;
  • Creating a documentation bank of key templates and reference documents to frame and guide key communications and engagement with Boards at each stage of the Performance Framework;
  • Establishing and implementing framework governance arrangements, including both within SG and any relevant external agencies;
  • Establishing and implementing a Performance Framework communications and engagement strategy and plan, for internal SG communications, engagement with Boards and relevant third party agencies;
  • Exploring the establishment of digital and IT platforms for supporting an interactive library for the performance framework for all key stakeholders;
  • Implementing the Performance Framework.

Initial director level engagement and review of framework development work to date is scheduled for early 2019 and the feedback from this will assist in shaping the key milestones in each of the workstreams above.

The key learning outcomes from NHS Tayside, the engagement with other territorial Boards facing financial challenge and the workstreams outlined above in developing a Performance Framework, together with the key steps being taken to ensure that these lessons are shared effectively to add value, are summarised at a high level in the table below. This involves using our learning to shape both the development of the Performance Framework and day to day interactions.

Focus area

Lessons learned

Adding value through lessons learned

Leadership and governance
  • A strong, driven, committed and effective leadership team is essential for each Board, with culture and strategy being driven from the top down.
  • Accountability and constructive challenge is key at Board and SG level in terms of ensuring all Board members are held to account and that the Board fulfils its purpose and effectively leads and drives the senior management team.
  • Within SG, consideration and assessment of leadership and governance should be inherent within all interactions with Boards and where this is falling short of expected standards it should be constructively challenged.
  • The inclusion of the consideration of leadership and governance as part of formal assessment criteria within the development of the Performance Framework to ensure that it is considered and assessed at least monthly and corrective actions can be agreed as appropriate.
  • The communications and engagement strategy supporting the Performance Framework will have clear and consistent messaging on leadership and governance which will be shared with all relevant stakeholders.
  • The Cabinet Secretary has discussed this issue as part of regular meetings with NHS Board Chairs and Chief Executives to ensure messaging around effective leadership and accountability are reinforced and understood throughout the NHS in Scotland.

Addressing the challenge
  • As a growing number of Boards enter new territory in terms of addressing the financial and operational sustainability challenges, Scottish Government requires to work collaboratively with Boards to ensure expectations are transparent and clearly understood and that outputs add value and address the root causes of current challenges.
  • The 'spirit' of the Performance Framework will be improvement focussed and will promote a collaborative and open dialogue between the Boards and SG. This will involve more frequent, informal engagement with Boards alongside formal director led meetings.
  • Reporting is designed to ensure 'early warning signals' can be identified and corrective action taken as required.
  • A review of SG team structure and capacity to provide support to Boards in addressing financial and operational sustainability challenges is underway to ensure that the current resource is aligned with Boards' needs and any gaps can be met with intermediate/ external support until these are more sustainably addressed.
  • The development of the Performance Framework includes steps to create an interactive documentation bank, which will include prescriptive guidance shaping communications with Boards and reference material available to Boards at every stage of the Performance Framework.
  • All current formal correspondence is in the process of being reviewed to ensure it is aligned with purpose and all new documentation will be created with these objectives in mind.

Financial, operational grip and service reform
  • In order to deliver a sustainable and integrated health care system, it is essential for all Boards to ensure that their focus is three fold, encompassing:
    • short term (in year impact): maximising financial and operational grip
    • medium term (1 - 2 year impact): optimising the current service configuration through operational and service improvement
    • long term (2 year+ impact): whole system reform to ensure a sustainable model of care encompassing accountability of individuals to self-manage and accountability of services to improve the health and wellbeing of the population
  • All Boards escalated to Stage 3 or above in the Performance Framework are required to prepare a formal Recovery Plan that confirms how the Board will ensure financial balance and sustainable service provision, including over the three time horizons.
  • Prescriptive guidance on what is expected in terms of the scope and content of a Recovery Plan has been prepared and is being piloted with a number of Boards.
  • The principles of effective recovery planning will be shared with all Boards as part of the communications and engagement strategy to drive consistent and pro-active messaging around addressing current challenges.
  • Workshops are being set up with input from external experts to share learning and experience on transformational change from comparable health systems to promote shared understanding across the relevant SG directorates of the nature and scale of the change and transformation requirements across NHS in Scotland.

Capacity and capability to drive and implement the required changes
  • Given the nature and scale of change needed, Boards require to ensure that they are adequately resourced to develop and implement the scale of change and reform required for recovery.
  • Boards may need external support to identify and secure the necessary specialist skills.
  • Boards escalated to Stage 3 and above of the Performance Framework are obliged through their Recovery Plan to provide details and evidence of their resource and programme management arrangements.
  • Key principles and high level guidelines in terms of expectations will be communicated to all Boards as part of the communications and engagement strategy supporting the Performance Framework.

Early warning signals
  • The approach to engaging with and assessing Boards should be focussed on an 'early warning signal' approach, ensuring that issues and challenges can be identified and tackled as early as possible
  • The work on developing consistent assessment processes is focused on ensuring that the criteria used to assess Boards are designed to highlight early warning signals in terms of financial, operational performance and governance challenges in order that issues can be identified and addressed as early as possible.
  • More regular, informal dialogue with the Boards will support in ensuring issues are identified as early as possible.

SG engagement with Boards
  • Scottish Government should work to ensure a joined up approach to interaction with individual Boards to avoid duplication of effort to promote a consistent message around the need for an integrated, full-system approach to recovery.
  • The current workstreams underway on the Performance Framework promote a more integrated, joined up approach, with work underway involving finance, quality and performance teams.

Contact

Email: Yvonne Summers

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