KERRY ROGERS, DIRECTOR OF CORPORATE SERVICES/COMPANY SECRETARY

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1 Bard f Directrs Meeting Reprt Subject: Gvernance Framewrk Date: 30 th Octber 2014 Authr: KERRY ROGERS, DIRECTOR OF CORPORATE SERVICES/COMPANY SECRETARY Lead Directr: KERRY ROGERS BACKGROUND A Bard s prpsed gvernance framewrk was presented t the Bard f Directrs at its December 2013 meeting and articulated simply all f the key systems and structures t gvern the relatinship between the Bard f Directrs and the Executives hlding functinal respnsibilities fr peratinal delivery. The devlutin f respnsibilities t the Divisins had been the subject f Bard debate back in early Having apprved the future state at that Bard meeting, it was necessary t implement changes t the gvernance framewrk, which invlved: Amending gverning framewrks defining decisin rights and escalatin paths Detailed design f the crprate gvernance perating mdel and its cmpnents Develping a matrix defining Trust accuntabilities acrss the executives Mapped gvernance requirements t rganisatinal functins and business requirements Amending gverning framewrks defining decisin rights and escalatin paths A rbust review f the Trust s Cnstitutin, Standing Orders and Scheme f Delegatin was undertaken culminating in significant revisins t these gverning dcuments t help enable the executin f gvernance respnsibilities at all levels and t ensure cmpliance with statute. The full suite f gverning dcuments, including changes t the SFIs t be presented by the CFO at Nvember Bard, and the subsequent revisin t the Bard standing cmmittees make clear reprting lines and linkages, risks, and ther matters t cme t the attentin f the Bard r its cmmittees fr review r apprval. This prmtes an understanding f rles and respnsibilities, limits f authrity, and means f escalatin at a crprate gvernance level. Detailed design f crprate gvernance perating mdel and its cmpnents The Bard f Directr s Cmmittee structure was critically evaluated and a new structure implemented in April 2014 fllwing apprval by the Bard, diverging and develping the wrk f the Bard Cmmittees away frm peratinal matters twards matters f strategy, crprate gvernance and assurance alngside versight f the management f quality, perfrmance and risk. The restructure als incrprated the recmmendatins f the PWC gvernance review implementatin f which was mandated in rder that the Trust cmplied with its explicitly stated Discretinary Requirements. The Cmpany Secretary develped Terms f Reference fr the Standing Cmmittees f the Bard which were subsequently apprved alng with annual wrkplans. The Bard and its cmmittees are clear n what they need t versee, and management and its

2 cmmittees have clarity regarding regulatry and gvernance cnsideratins t address as well as risks t perfrmance and quality t manage. In parallel with the changes t the Bard s Cmmittee structure, enhancements were develped cncerning the peratinal gvernance infrastructure t safeguard the management f quality, perfrmance and risk, and change cmmenced early in 2014 with the intrductin f a new Trust Management Bard. The Cmpany Secretary develped Terms f Reference and a cycle f business fr the Trust Management Bard t be executed by a prpsed TMB Cmmittee structure which was apprved by the Executive Team and TMB. The apprved Executive Chairs and Leads f each TMB Cmmittee were required t develp Terms f Reference, Wrkplans and Sub Cmmittee structures such that clinical and peratinal gvernance matters were apprpriately verseen acrss the entire cycle f business. Sub structures and Terms f Reference fr each TMB Cmmittee were subsequently apprved, and with regard t clinical gvernance, the CG&Q Cmmittee cntinued t adpt the sub structures that had previusly supprted the Clinical Management Team, pending cmpletin f a sub cmmittee review which had been initiated and was at the time being undertaken fr CMT by Sally Seeley and subsequently the Head f Gvernance within the GSU. Develping a matrix defining key accuntabilities acrss the executive The accuntabilities f the Executive Team were evaluated and it became clear there was an absence f clarity. It was accepted it was very imprtant fr the team and all stakehlders t understand the respnsibilities and accuntabilities f each executive given the cmplexities as an acute prvider and the crss-department and inter-rganisatinal cllabratins, s a mre frmal prcess t track respnsibilities and pririties was develped. The accuntability matrix was initiated in rder t ensure all functinal accuntabilities had a single executive lead assigned fr the strategic directin, leadership and perfrmance management f each functinal area f the Trust and wrk was undertaken t ensure that knwledge and understanding acrss the Team and acrss the accuntabilities utlined, was held by each executive lead, alngside an understanding f priritisatin perspectives. On cmpletin f the matrix and priritisatins, each executive was accuntable fr ensuring they had capacity and capability individually and amngst their teams in rder t deliver acrss individual spheres and t pick up any gaps with the Chief Executive. Executives prduced team structures t ensure clarity acrss the executive team and t facilitate individual assessments f team capacity. Crprate and Clinical gvernance framewrks The basics f gvernance within healthcare system are that bundaries between crprate and clinical gvernance, are well understd t be effective. The Imprvement Directr has been wrking with the Executive Directr f Nursing thrugh recgnitin that ne aspect f imprved perfrmance is clarificatin f the rles and respnsibilities in the peratinal and clinical gvernance arms f the Trust. Fr the purpses f the Trust s gvernance framewrk, driven by the wrk initiated by the Imprvement Directr, it is imprtant and timely t clarify the linkages and bundaries between crprate and clinical gvernance, and t g n t make transparent the high level Accuntability Framewrk n which the Imprvement Directr has been wrking with the Cmpany Secretary. Crprate gvernance is a multifaceted set f prcesses, plicies, regulatins, laws, rganisatinal structures, peple, and custms. These shuld all wrk in cncert t assure the quality, accuntability and effective management f the Trust as a whle. The highest level f crprate gvernance in a Fundatin Trust (with the exceptin f the CG) is the Bard f Directrs which shuld ensure that: results are delivered, and

3 resurces are prudently managed. The Bard discharges these respnsibilities in the same way as any crprate bard des thrugh activities such as: appintment and evaluatin f the CEO; engagement with the CEO and senir management in setting the strategy f the rganisatin; identificatin and management f any real r perceived cnflicts f interest amng directrs and/r fficers; assessment f the cntributins f each individual bard member as well as the cllective perfrmance f the bard; ensuring that new bard members are thrughly riented t the rganisatin and the peratins f the bard; underscring that the interests f the stakehlders are paramunt Risk management cmpnents (BAF) NED independence and gvernance structures that supprt effective decisin making Much mre can be written abut crprate gvernance in general. Hwever, tw key practical elements in the cntext f this paper deserve special mentin: 1. Accuntability well functining bards define clear lines f accuntability fr the CEO and his team (e.g. peratinal matters) and reserve certain accuntabilities squarely fr the bard per se (e.g. audit). Accuntability invlves frmal delegatin f respnsibility and intermittent review f such delegatins. 2. Transparency effective bards perate penly and transparently. This is especially imprtant where the public places the trusteeship fr its health care in such an entity as a Fundatin Trust. The name clinical gvernance emerged in the United Kingdm where the Natinal Health Service defined clinical gvernance as a framewrk thrugh which rganizatins are accuntable fr cntinually imprving the quality f services and safe guarding the high standards f patient care by creating an envirnment in which excellence in clinical care will prevail. The basic elements f clinical gvernance/quality-safety include: emphasis n educatin and training fr prfessinals; clinical audit systems cyclic review f clinical perfrmance against measurable standards with changes in clinical practice upn such review; assessment f clinical effectiveness whether a particular actin wrks and whether it represents value fr expenditure etc.; research and develpment t generate evidence t infrm decisins abut plicy and implementatin changes; penness t enable frank discussins abut safety and quality matters while respecting cnfidentiality f patients and prviders; cmmittees and prcesses t ensure that these elements ccur; risk management cmpnents (CRR, dept risk registers) Linkages and Bundaries between Crprate and Clinical Gvernance Crprate and clinical gvernance can each have intrinsic prblems. Hwever, the linkages between crprate and clinical gvernance shuld be clear. Under delegatin frm the bard, the management team shuld implement the clinical gvernance systems and prcesses arund patient

4 safety and quality. A key aspect f that wrk is t reprt t the bard (and therefre the wider stakehlders and the public) that: delivery f high quality clinical services is happening and that it is measurable and effective; patients are being cnsistently cared fr in a safe and dignified manner; and that the mechanisms t cnstantly imprve upn prir utcmes are in place. With regard t clinical gvernance, the rle f the bard includes respnsibility t: endrse plicies and clarify expectatins regarding the desired utcmes fr the CEO and management team with respect t patient safety and quality; receive, review and react t regular reprts n clinical perfrmance frm the CEO and management team. expect that such reprts shuld be sufficiently detailed s that the bard can assure itself that the Trust is perfrming in accrd with frmally recrded expectatins but nt be s exhaustive that ptential prblem areas are lst r disguised in the detail; be assured that apprpriate remediatin steps are activated fr prblematic areas. The bundaries between crprate and clinical gvernance shuld als be clear. First, it is imprtant t recgnise that crprate gvernance cvers many matters nt tuched upn in any detail by clinical gvernance (gverning dcuments; legal cmpliance etc.). Secnd, it is the clinical gvernance arm which deals with implementing the detailed prcesses and structures needed t deliver quality healthcare, nt the bard. In terms f bth accuntabilities and transparency, the tw key areas f gvernance mentined earlier, the Imprvement Directr has been wrking with the Executive Directr f Nursing in rder t clearly articulate the linkages between the TMB Cmmittees and their sub cmmittee structures, predminantly thse supprting clinical gvernance thrugh the CG&Q Cmmittee thrugh which a substantial share f imprvement activity will be mnitred as driven by the Kegh/CQC inspectins. The refreshed Sub Cmmittee structure presented t Nvember Bard by the Executive Directr f Nursing eches the mdificatins this wrk has prduced reflecting als n the changes that have been seen in past mnths, in particular incrprating the findings f the Chief Inspectr f Hspitals regime and the special measures prcess. It als reflects ut learning frm ur first year as a new Bard. The Executive Directr f Nursing will present the visual depictin f the linkages between TMB Cmmittees and their supprting substructures such that clarity is prvided regarding clinical and peratinal gvernance acrss the Trust, and hw that fits within the wider crprate gvernance structures apprved by the Bard f Directrs in December Mapped gvernance requirements t rganisatinal functins and business requirements The Imprvement Directr has als been wrking with the Cmpany Secretary n the accuntability framewrk. The accuntability framewrk sits alngside ur crprate gvernance framewrk and cvers the Trust s apprach t measuring and verseeing perfrmance and quality; t escalatin and interventin; t the prvisin f supprt fr imprvement; and t the way we mve the Trust twards a sustainable future in supprt f the crprate, peratinal and clinical gvernance structures. While sme f the detail has changed in terms f the sub-cmmittee structures, the Bard Standing Cmmittee Structure remains as agreed by the Bard f Directrs at the December 2013 Bard meeting and the cre principles underpinning imprvements t the accuntability framewrk are cnsistent. The Framewrk aims t be hlistic and integrated, setting ut in ne place f all ur key accuntabilities and supprting a single cnversatin between the Bard and the wider rganisatin.

5 Secndly, ur apprach is clsely aligned with that f ur partners, particularly regulatrs and cmmissiners in terms f capturing Better Tgether pririties fr instance. Thirdly, ur clear fcus n quality is stitched thrughut the gvernance structures. It sits at the heart f ur versight and apprvals mdels and it is central t ur develpment wrk. Imprving quality at the same time as maintaining financial cntrl represents a mre difficult equatin than ever fr the Trust given its ambitius lng term financial plans predicated n the success f system wide strategies and successful hard hitting efficiency drives, but it is an equatin we must cntinue t slve. A well-designed rganizatin ensures that the frm f the rganizatin matches its purpse r strategy, meets the challenges psed by business realities and significantly increases the likelihd that the cllective effrts f peple will be successful Fcussing n develping and supprting ur Bard and ur staff remains a key pririty fr the Trust. The challenge f mving twards sustainability is nt abut quick fixes, but rather a lng term prcess f imprvement, based n a deep understanding f rganisatinal needs. S we want mre than ever t fcus n supprt and develpment and n imprving culture, leadership and gvernance and the cmbinatin f successes emanating frm the Quality Imprvement Plan and the transfrmatin agenda shuld deliver cllectively n thse ambitins. Actin Required by Bard f Directrs: 1. T identify any additinal clarificatins with regard t the high level Accuntability Matrix and cmmittee linkages 2. Bard Cmmittee Chairs t agree respnsibility fr ensuring the apprpriate versight thrugh Cmmittee wrkplans

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