NHS Tayside Transformation Support Team: second progress report

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."

NHS Tayside's Assessment

"The Board Secretary held scoping meetings with the Chairman, Vice Chairman, Chief Executive, Medical Director, Employee Director, Chief Internal Auditor and Chair of the Finance and Resource Committee to discuss the changes required to NHS Tayside's governance structure to ensure performance management and scrutiny is carried out. A Short Life Working Group was established and met on 28 September and 14 November 2017. From the work of this group, a report was presented to Tayside NHS Board at its meeting on 26 October 2017 providing an update. A further report was taken to the Board meeting on 7 December 2017 describing the proposed changes to NHS Tayside's Standing Committee structure.

The most significant change is the development of the Finance and Resources Committee into a Performance and Resources Committee. The work of this new Committee will be underpinned by new performance management arrangements across all services in NHS Tayside and this will also allow new public reporting on NHS Tayside's performance to be put in place.

The Transformation Programme Board Terms of Reference have been considered as part of the overall review of Tayside NHS Board's Standing Committees. This was included in the update report that was taken to the Board meeting on 7 December 2017 describing the proposed changes to the Board Standing Committee structure.

The first year of the new integrated Budget Planning and Performance commenced in November 2017 ( Recommendation 2). Development sessions were arranged with Board Non-Executive Members to inform the process of budget planning and scrutiny. Non-Executive Members will form part of the panel for the final budget reviews in February 2017. The outcomes from the process, aligned with workforce planning, will inform the updated One Year Operational Delivery Plan for 2018/19.

Next Steps

A finalised paper will be taken to the Board meeting in February 2018 describing the changes to the Code of Corporate Governance to allow the new governance structure and supporting arrangements to be in place for the new financial year. The continued cycle of performance reviews for Acute Groups will continue with Health and Social Care Partnerships performance review outcomes to be submitted to Committees with performance review dates."

TST comment

Our previous report in September highlighted that the establishment of the Programme Management Office and the Transformation Programme Board were important elements of the arrangements we expected to see being put in place to report on and monitor progress against the AAG recommendations.

The TST fully supports the next phase of this work as highlighted above, to strengthen scrutiny at both a Board and Committee level. The creation, from April 2018, of a Performance and Resources Committee will enable members to take an integrated view of both financial and operational performance and facilitate the discussion of the common factors which impact on both sets of indicators. It is anticipated that the new structure will also support a more transformational focus at the main Board meetings.

To complement this, we have seen evidence of both Committee and Board agendas and discussions becoming more strategically focussed with less time devoted to operational detail. We have also seen improvements in the presentation of supporting Board papers, although the quality of covering papers can be variable in clearly highlighting the central points or the key statistics which should inform decisions.

We would highlight a concern about the observed practices of circulating key papers very close to the date of meetings, along with regular verbal presentations or updates where the information is not circulated in advance. We note that in some cases this may be an unintended consequence of the increased pace of transformation work. Nonetheless, it can impact on the ability of Board members, particularly Non-Executive Members, to fully consider the issues, to effectively hold Executive leads to account or to make decisions on a fully informed basis. Consequently, NHS Tayside should make efforts to minimise instances of this and put in place safeguards to ensure Board members have the opportunity to consider and revisit key issues addressed in short notice papers or presentations. Linked to this, NHS Tayside needs to ensure that Non-Executive Members and staff-side, get appropriate support and training to understand the papers and proposals that are presented to them.

Considering the specific elements of scrutiny relating to budgetary control and strategic planning, previous mention has been made to the improved financial reporting which has improved transparency. The regular Delivery Reports produced by the Programme Management Office for the Transformation Programme Board and monthly financial outturn reports provide good examples of performance focused reporting which underpins robust scrutiny. The response to these reports has been positive, although there have been instances where the level of constructive challenge observed might have been more rigorous and outcome focused - particularly given the significant nature of the issues under discussion.

The most recent Board reports and discussions around the ICS Staging Report have provided evidence of progress that Board members are aware of the complexity of the work still required and the importance of getting it right. This will continue to be one of the most important pieces of work for the Board over the next year and Board Members will continue to require support to make sure they are able to ask the right questions to ensure it stays on track.

TST rating in September 2017 = Amber
TST rating in January 2018 = Amber