PLYMOUTH HOSPITALS NHS TRUST. Minutes of the Meeting of the Audit Committee. Held on Wednesday 11 April 2007

Transcription

1 PLYMOUTH HOSPITALS NHS TRUST Minutes of the Meeting of the Audit Committee Held on Wednesday 11 April 2007 Present: In Attendance: Mr N Taylor Ms M Schwarz Mr AJ Beecher Professor RJ Bull, Chairman PHT Mr D Woods, Bevan Brittan Miss H Ancient, PricewaterhouseCoopers Mr M Winch, Devon & Cornwall Internal Audit Confederation Miss R Tomlinson, Devon & Cornwall Internal Audit Confederation Mr J Yarnold, Director of Finance PHT Mrs S Wilson, Financial Accountant PHT Minute 07/09 Apologies for absence Apologies had been received from Mr Bacon, Mr Whyte, Mr Cooper and Mrs Wheeler. Minute 07/10 Minutes of the meeting held on 7 February 2007 Re minute 07/02 (payroll overpayments) Mr Yarnold confirmed that Malcolm Speak would be invited to the next meeting. Re minute 07/03 Mr Yarnold said that income for diabetes had been included in the 07/08 figures although it was outside PbR. Re minute 07/04 Mr Yarnold said that there was now a clinical champion in this area: Richard Best and James Palmer were working on this as well as medical records and the Bush Park service. Re minute 07/06 Mr Winch confirmed that Internal Audit were supporting the work on the business plan and drawing together the lessons learned from the process so far. Minute 07/11 Bevan Brittan: Risk update Mr Taylor introduced David Woods of Bevan Brittan to his first audit committee at the Trust explaining that the committee had felt that a regular briefing on risks and potential risks would be useful. Mr Woods said that he felt that he could add value to the work of the 1

2 committee by outlining the work that his firm had been doing for the Trust and highlighting any recurrent themes and also by using his firm s experience at other NHS organisations to look at possible future risks. He would also arrange presentations to the committee on any particular area as appropriate. He said that the cost of legal work had decreased considerably over the past few years, chiefly because medical negligence cases were now dealt with by the NHS Litigation Authority. Main areas dealt with recently had included issues relating to Vanguard, employment law where there were a few difficult cases ongoing at the moment, property matters and commercial issues. Training within HR recently had meant that his firm was being called on to answer many fewer basic employment law questions. Inquest costs had also reduced significantly, although it was felt that this could be the result of a change in the Plymouth Coroner. Bevan Brittan were currently involved with the risk register and assurance framework and had recently been successful in gaining access to the database, so Mr Woods expected to be able to discuss this in more detail at his next committee attendance. He explained that as the Trust prepared for Foundation Trust status this would become increasingly important. Commissioning arrangements would also have to be tightened up since under the FT regime they would become legally enforceable documents. Mr Woods suggested a seminar for the Board on an aspect of Foundation Trust status, perhaps looking at banking and borrowing and it was agreed that this would be useful. Mr Yarnold asked whether there were any trends across the country in terms of medical negligence. Mr Woods was not aware that there were but would enquire. Mr Yarnold said that much of the routine work previously done by Bevan Brittan was now carried out by Richard Evans and his team and Mr Woods agreed that this arrangement worked well, with the Trust legal team properly aware of the boundaries of their expertise. The committee agreed that they had found Mr Woods briefing useful and that Mr Taylor and Mr Yarnold would decide the frequency of future briefings. Minute 07/12 PricewaterhouseCoopers: Interim Progress Report Miss Ancient explained that her firm had recently completed their interim audit visit looking at controls in place, work carried out by Internal Audit and changes since the previous year. She confirmed that she would be able to rely on the work of Internal Audit. The main area of concern with regard to controls was ESR where she thought more substantive testing would be necessary this year in the absence of some key controls. Otherwise the overall control environment was satisfactory, with just 2

3 some development of the risk register required. The firm s IT specialist had reviewed the Trust s IT systems and given a clean opinion in this area. Financial standing had been reviewed and was looking promising. The firm s ISA260 report and annual audit letter would be brought to the June audit committee which would be their final committee meeting. Mr Taylor said that the committee was not happy that some of the audit recommendations were still outstanding from previous years. The risk register was still a concern. Mr Yarnold commented that the well run directorates were not only the ones in surplus but were also the ones with properly completed risk registers and indeed performing well in every area. Professor Bull said that it was absolutely essential that every directorate understood what was required of them in this area. Once again it was stressed that they were not being asked to carry out additional tasks, merely to evidence what they were already doing. Mr Winch said that he had agreed with Angela Edmunds that Internal Audit would work with Child Health on their risk register over the next few weeks and then take this work as an example to the Risk Launch in May. MW Miss Ancient explained the ALE scoring for the current year saying that there had been some difficulty in obtaining the required evidence, so there was a risk that at moderation the score might go down. If Mr Yarnold could make the paper evidence available immediately this would be helpful. Mr Beecher said that he was particularly disappointed to see that the comments on poor controls over private patient income were still there. He said that the fact that the computer system had limitations was not an adequate excuse for failing to identify this income. Mr Yarnold said that Ray Stringer would be invited to the next committee meeting to give a presentation on all aspects of private patient income but particularly his plans for dealing with the current failings. The committee discussed the recommendation for disabling the computer access of ex-employees after 18 months and suggested that 3 months would be more appropriate. Professor Bull said that the entire process surrounding leavers needed tightening up and that HR should develop a system that took into account complications such as secondments. CL-J? Minute 07/13 PricewaterhouseCoopers: Medical Secretaries update Miss Ancient presented the final review of Medical Secretaries in ENT and Gastroenterology. The two areas were very different, with a very positive report on the findings in Gastroenterology but less to commend 3

4 in ENT. Mr Yarnold commented that again it was interesting that every aspect of Gastroenterology is entirely satisfactory. He went on to say that the work currently being carried out by James Palmer looked at every aspect of clinical administration and Professor Bull suggested that Mr Palmer could do a seminar on the subject for the Board. Mr Winch added that the work was important in that it led to the efficiencies underpinning next year s plan for financial balance. Minute 07/14 Director of Finance: Annual Accounts progress Accounts would be submitted to the Department of Health on 1 May. Mr Yarnold and Mrs Wilson confirmed that work was currently on schedule, but that the difficult area still to come was the agreement of balances with other NHS organisations. Miss Ancient confirmed that at Month 9 the Trust had done all it could to complete the agreement exercise in line with guidance, but that it was dependent on the other organisations doing the same. Minute 07/15 Director of Finance: update on Internal Control action plan Mr Yarnold went through the nine main areas explaining where there was still work to do. As discussed earlier in the agenda, there were concerns around extending the assurance framework to directorate and departmental level. There were also some outstanding actions in respect of implementing the action plan drawn up from the integrated governance handbook. In particular the Clinical Governance committee was not to become a sub committee of the audit committee, and the audit committee s terms of reference would need to be changed to reflect this. It was agreed that these would be brought to the next committee meeting for approval prior to Board ratification. SCW Development of the Datix system had been slow, but the decision had now been made to upgrade to a web based system which would allow the integration of complaints and incident reporting. Mr Winch said that he would find this update very useful in his drafting of the Head of Internal Audit opinion, which would need to be completed at the same time as the Statement on Internal Control. A draft of this document would be prepared the following week. MW Minute 07/16 Local Counter Fraud Officer: update and annual plan Mrs Wheeler was unable to attend the meeting. Mr Yarnold explained that he had agreed to increase the number of days spend on counter fraud. For a Trust of PHT s size the recommended number of days was around 120, whereas our plan included only 60 days and in 06/07 around 50 of these had been spend on special investigations leaving little time for 4

5 fraud awareness work. Mr Yarnold said that he had agreed a budget of 80 days and that a detailed plan of how these would be used would be brought to the next meeting. Mr Taylor commented that if there were so many investigations this year there was clearly a need to do more preventative work. TW Minute 07/17 Director of Finance: Standards for Better Health process and declaration Mr Yarnold explained that this paper merely summarised work that had been discussed at the last board meeting and would be discussed again at the next so there was no need for detailed consideration here. Mr Beecher remarked that the Trust was extremely candid in this area and wondered whether all Trusts were as honest. The general feeling was that most Trusts recognised that openness was essential. Minute 07/18 Director of Internal Audit: Interim Report Mr Winch presented his report summarising work completed since the previous committee meeting and work in progress. Three reports had been waiting for management responses for an unacceptable length of time. Mr Cooper would be at the next committee meeting and would be able to comment on the issues affecting his area. In addition to their normal audit work, Internal Audit had been supporting the migration to Shared Business Services. Mr Yarnold said that this had been difficult right up to the last few hours before go live, but that the Trust had gone live on 1 April and that the new system was in use. Mr Taylor asked whether Internal Audit would assist the committee in preparing its annual report again this year and Mr Winch agreed to do this for the June meeting. A follow up review had been carried out in Estates and the report was discussed in some detail. The committee was dissatisfied with the progress made by the Department and by their responses to the recommendations. Mr Steele would be invited to the next committee meeting to outline progress made and to explain the delay. Mr Yarnold would arrange to see Mr Steele within the next week. There were also some concerns around a report on Research and Professor Bull undertook to mention these to Professor Zajicek. MW RJB Minute 07/19 Director of Internal Audit: Strategic Plan 2007/10 Mr Winch presented the strategic plan covering the next three years, pointing out an increase in the number of days by an additional hundred 5

6 each year. Mr Yarnold confirmed that this was affordable and the Internal Audit had proved their worth over the last few years. Mr Winch went on to outline developments in the proposed service, saying that he planned to design KPIs so that it was possible to quantify the value added. Minute 06/70 Any other business Professor Bull noted that this was Mr Taylor s final audit committee meeting. On behalf of the Trust he thanked Mr Taylor for his chairmanship of the committee and praised his insight, authority, challenge, persistence and humour. Mr Taylor replied that he had been grateful for the work done by both internal and external audit as well as the Director of Finance and that he felt that the committee had worked well as a team. Ms Schwarz would be taking the chair of the committee in future. Date of next meeting: 11 June