NHS Tayside Transformation Support Team: report

9. AAG Recommendation 9 – Scrutiny

"The Board should ensure that the actions (Actions 1-6) recommended for the senior executive team are rigorously scrutinised and governed to ensure effective and timely delivery. Restructuring of its financial framework control systems must ensure that budgetary control is assured for all its functions (see Action 2). In particular, leadership and continuous scrutiny of a very high order will be required for all aspects of strategic planning to deliver sustainable transformation over the next five years."

9.1 NHS Tayside's Assessment – Rating = Amber

"The Board and Executive Team are fully focussed on the 10 recommendations from the AAG Report to take forward improvement action across financial delivery and planning, service strategy, transformation, organisational design and development. There is strong evidence of executive leadership portfolios and collective leadership through the establishment of an Extended Senior Leadership Team ( ESLT) and Executive Review Team ( ERT). The ERT works on a daily huddle basis to review and monitor ongoing actions while the development of an action plan tracker has enabled the progress to regularly updated and reviewed on a weekly basis supported by an evidence base and shared with the TST. The lead executives have developed strong partnership working with lead staff side representatives for each of the improvement recommendations and associated action plans, working closely with designated TST members. There was an observed positive and constructive challenge from non-executive members at the most recent Board meeting and its supporting sub-committees, further evidencing an enhanced level of scrutiny and challenge. At this stage, given the steady progress made and the need to maintain momentum, the status of this recommendation is 'Amber'."

9.2 TST Comment - Rating = Amber

The TST acknowledges the action that the Board has taken to track progress against the AAG recommendations and agrees that these arrangements have been proved to work effectively over the last few months. TST members attending Board meetings have also observed a welcome focus on key priorities, informed debates and engaged Non-Executive Directors providing constructive challenge to the senior management team. However, we note that, at this stage, all the recommendations are rated Red or Amber. The question, therefore, becomes how is how quickly these might be expected to move to green and how effectively any necessary corrective or supplementary action is identified and put in place on the back of the Board's scrutiny processes.

Finally, and as noted elsewhere, NHS Tayside is still lacking senior level Strategic Planning capacity. The TST recognises that this is a significant gap and that securing dedicated capacity in this area would facilitate and augment delivery. We are committed to supporting resolution of the situation as soon as possible.

Over the next three months, the TST would expect to see continued scrutiny of progress by the Executive Team and the Board. This should include a regular focus on ensuring that the actions being taken are delivering the impact anticipated or agreeing how the situation will be remedied. The TST will also continue to work with the Board to address the skills gap in relation to Strategic Planning.