Summary Exception Report of the Finance Committee meeting minutes 11 th September 2017

Transcription

1 Summary Exception Report of the Finance Committee meeting minutes 11 th September 2017 EXCEPTION REPORTS Name of Committee Chair of Committee Senior Officer Supporting Committee Audit & Risk Assurance Committee Ms Margaret Schwarz, Non-Executive Director Sally May, Joint Chief Finance Officer Date Committee Held 11 th September 2017 Key Decisions and Matters Considered by the Committee 1. Audit South West Interim Report 1.1 The Committee received the Audit South West Interim Report and noted the changes to the Audit Plan as well as the status of audits currently in progress. It was noted that two Audits relating to End of Life Care 2016/17 and Discharge Planning and Medicines Management at the Point of Patient Discharge Follow up Review 2016/17, had identified that further work was required. The recommendations made were being addressed and monitored by the Quality Assurance Committee and once this work has been completed re-audits will be undertaken to see whether the actions, once implemented, deliver the changes required. 1.2 The Committee has no assure has clinical governance within the Trust is adequate to provide safe care for our patients, and whilst it notes the verbal update to be given further down the agenda, it expects an update on actions to be provided at the next meeting, if not sooner. 2. Audit South West Consortium Update 2.1 A verbal report was received confirming that the next meeting of the Consortium Board would take place on Friday 15 th September The Annual Report and six monthly progress update would be the key items for discussion. 3. Counter Fraud Interim Report 3.1 The Committee received an update on the Counter Fraud activities including investigations. Mr Cottrell reported on the positive NHS Protect Quality Assessment recently conducted on his service. The NHS Protect outcome report was expected to be received within 4 months. 4. Counter Fraud Annual Report 2016/ The Committee received the Counter Fraud Annual Report for 2016/17 the contents of which were noted. 5. Grant Thornton (External Auditors) 5.1 Audit Update Report A progress report was received which also contained emergency issues and developments for the year ended 31 st March The Committee welcomed the information provided relating to the Vibrant Economy 1

2 Index. 5.2 Quality Accounts Report 2016/17 The Trust had received an unqualified conclusion and no specific issues had been brought to the Trust s attention. 5.3 Annual Audit Letter (year ended 31 st March 2017) Recommendation were received regarding financial sustainability and these would be added to the Recommendations Register for monitoring. The Committee asked that the final accounts sign off meeting in 2018 be held further in the advance of the due date than it was held in Risk Management Report 6.1 The Committee received a report which covered the 6 principal risks overseen by the Committee. The Trust s Risk Management Strategy was being reviewed and at future meetings risks below tolerance level would be included in order to increase visibility to the Committee and promote their management. 7. Audit Committee Annual Report 7.1 The Committee received a report regarding its activities and effectiveness during 2016/17. The Committee approved the report for presentation to the Trust Board and it is enclosed at Appendix A. 8. Trust Annual Report 2016/ The working draft version of the Trust s Annual Report for 2016/17 was received by the Committee. Due to significant editing provided by Dr John Lander, but not included in the version to the Committee, the Committee asked for sight of the latest version before providing comments. Once the revised version is received the Committee will provide feedback or required amendments by Friday 15 th September Single Tender Actions 9.1 The single tender actions recorded between 11 th March 2017 and 10 th August 2017 were noted. 10. Clinical Audit Verbal Update 10.1 The Committee received a verbal update from the Trust s Medical Director on the work being undertaken to implement improvements to the Trust s Clinical Audit structure and processes, both centrally and at Divisional level. An update report would be received at a future meeting. 11. Review of Standing Orders 11.1 The Committee noted that the review of the Trust s standing orders and associated documentation was underway. This would incorporate the e-governance amendment as already approved by the Trust Board. 12. Conflict of Interest Policy 12.1 The Committee received the Trust s revised Conflict of Interest Policy following new guidance issued by the Department of Health on 1 st June The Committee approved the Conflict of Interest Policy. 13. Losses and Special Payments Report 13.1 The losses and special payments for the year ended 31 st March 2017 and the 4 month period to July 2017 was received. 2

3 14. External Audit Procurement Update 14.1 There was a private discussion by Committee members regarding the forthcoming arrangements for the procurement of the Trust s external auditors. Following a presentation event a recommendation would be made to the Auditor Panel in November, and then to the Trust Board. Concerns identified and being managed at Committee/Sub Committee level Monitoring of the position in relation to the Trust s Clinical Audit infrastructure. Matters Requiring Board Consideration Audit Committee Annual Report. Conflicts of Interest Policy. Date of Next Meeting 13 th November

4 SUMMARY REPORT AUDIT & RISK ASSURANCE COMMITTEE 11 th September 2017 Title of Report Accountable Officer Authors Purpose of Report Recommendationn Consultation Undertaken to Date Date at which previously discussed by Trust Board / Committee Next Steps Annual Report on Audit & Risk R Assurance Committee Activities inn Sally May, Joint Chief Finance Officer Alexandra Bradshaw, Deputy Financial Accountant To presentt the activities of the Audit & Risk Assurance Committee during and review the effectiveness and impact of the Committee. The Committee is recommendedd to: Approve thee report for presentation to the Board. Agenda Number: 10 Thomas Lafferty, Director of Corporate Affairs and the Trust s Governance e Lead, has been consulted. There has been no previous discussionn of this report s contents. The activity of the Committee was discussed at its December 2016 meeting. The annual report will be presented to the 288 th September 2017 Board meeting. Executive Summary This report provides a summary of the activities of the Audit & Risk Assurance Committee in It provides assurance to the Board concerning these activities. Financial Risks Key Risks Disclosure Statement Equality and Diversity Statement Under its Terms of Reference, the Committee adopts a risk- responsibilitr ties, by consideration of the integrity, completeness and clarity of annual accounts andd statements and the risks and based approach to fulfilling its governance and accounting controls around financial management. Thiss forms part of the Board s approach to mitigating financial risks. Financial and Assurance, addressed as part of the Trust s annual Governance Statement. Audit findings report from External Audit. None specific. 1

5 AUDIT & RISK ASSURANCE COMMITTEE Annual Report on Audit & Risk Assurance Committee Activities in Introductionn 1.1. The purpose of this report is to provide the Trust Board with w a summary of the work of the Audit & Risk Assurance Committee of Royal Cornwall Hospitals NHS Trust (hereafter referred to as the Committee ) during the period 1 st April 2016 to 31 st March 2017 and, in doing so, comply with the Committee s Terms of Reference. 2. Terms of Reference 2.1. The Committee was established under Board delegation with approved Terms of Reference that are aligned with the Audit Committee Handbook The Terms of Reference for the Committee weree updated at its June 2016 meeting, along with its work plan, and reflect the Committee arrangements that t appliedd in The Terms of Reference and work plann were updated furtherr and approved at its February 2017 meeting This report sets out how the Committee has satisfied its Terms T of Reference during the financial year and seeks to provide the Board with evidence relevantt to its responsibilities for the annual Governance Statement. 3. Meetings and membership 3.1. The Committee consistss of three Non-Executive Directors and, per the following table, met on 5 occasions throughout the financial year, in Mayy 2016, June 2016, September 2016, December 2016 and February It has discharged its responsibilities for scrutinising thee risks and controls which w affect t all aspects of the Trust s business The Committee was chaired for the first four meetings by Roger Gazzard, Nonexpress Executive Director, who has the required financial expertise to enable him to informed views about financial management. The fifth and a final meeting was chaired by Margaret Schwarz. 2

6 26 May Jun Sep Dec Feb 17 Roger Gazzard ² Margaret Schwarz Dr Mairi McLean Paul Hobson ¹ Charlotte Russell ¹ denotes Chair 1. Paul Hobson and Charlotte Russell attended the 26th May 2016 (final accounts) meeting but were not members of the Committee at that time. 2. Roger Gazzard attended the 13th February 2017 meeting as an Associate Non Executive Director. 4. Delegated authority 4.1. Every NHS organisation is required to have an audit committee that reports to its governing body. The existence of an independent audit committee is the central means by which a Board ensures effective control arrangements are in place Under delegated authority, the Audit & Risk Assurance Committee independently reviews, monitors and reports to the Board on the attainment of effective control systems and financial reporting processes. In particular, the Committee s work focuses on the framework of risk, control and related assurances that underpin the delivery of the Trust s objectives The Committee receives and considers reports from both internal and external auditors and recommends the annual accounts and annual Governance Statement to the Board for approval. 5. Work plan: principal review areas 5.1. The next sections of this Annual Report reflect the following eight key duties of the Committee, as set out in its Terms of Reference, with the eighth being introduced for : 1. Governance, risk management and internal control; 2. Internal audit; 3. External audit; 4. Other assurance functions; 5. Management; 6. Financial reporting; 7. Counter fraud; and 8. Auditor Panel. 6. Governance, risk management and internal control 6.1. During the year, the Committee received assurance on governance, the system of internal control and the Board Assurance Framework, including actions to address principal risks. It commissioned deep dives into such risks, where deemed appropriate. 3

7 6.2. At its May 2016 meeting, the Committee reviewed relevant disclosure statements for , in particular the annual Governance Statement, the Head of Internal Audit Opinion, the External Audit Opinion and other appropriate independent assurances such as the Value for Money report, and considered them to be consistent with the Committee s view on the Trust s system of internal control At its June 2016 meeting, the Committee received a progress report on the Risk Management Strategy and Policy 2016, which was in the process of being updated to reflect work such as the 2015 governance review and Internal Audit reports on risk management in This document sets out the Trust s approach to using the Board Assurance Framework At the same meeting, the Committee noted the contents of a report on the use of the Trust seal, which is held securely and must be used in accordance with the Trust s Standing Orders, Standing Financial Instructions and Scheme of Delegation. It also noted a report on the declarations made by Trust staff with regard to gifts, hospitality and conflicting interests At its September 2016 meeting, the Committee approved an updated policy on gifts, hospitality, sponsorship and conflicting interests. It also received a paper from the (previous) governance lead on future arrangements regarding oversight of the Board Assurance Framework and risk management, further to the Committee s extended remit in this area during A report on the agreed deep dive into two partnership-related principal risks on the Board Assurance Framework ( The impact of system pressures on the Trust and Realising the benefits of more integrated health and social care services ) was presented at the December 2016 Committee meeting. This noted that there was limited assurance of effective whole system delivery and hence actions were underway to address gaps in control and assurance. It also noted progress in establishing a new collaborative agreement, initially between the Trust and Cornwall Partnership Foundation Trust, with the first joint venture being progressed in relation to urgent care, and a further collaborative approach to the future contract for NHS 111 services At its February 2017 meeting, the Committee received a risk assurance report from the (previous) Governance Lead. This referred to the Risk Management Strategy, as revised to incorporate the Risk Assessment Policy, which had been approved by the Board in December This document provides enhanced risk management and assurance arrangements, to ensure risk management is mainstreamed across the Trust, and focuses on managing risks according to tolerance levels. The Committee was also briefed on a Cornwall-wide review of patient flow, supported by key regulators (CQC/NHSI/NHSE), and that GE Finnamore would be scrutinising Trust plans as part of the Sustainability and Transformation Plan process The Committee provided assurance to the Board that governance, risk management and internal control arrangements were sound and, where necessary, set out where improvements could be made. 7. Internal audit 7.1. Audit South West provides internal audit services to a consortium of bodies that includes the Trust. At each meeting, the Committee received details of recent Internal Audit work, together with schedules of management s progress in implementing agreed actions. 4

8 7.2. The Head of Internal Audit Opinion for was presented to the May 2016 meeting for note. This summarised Internal Audit s work regarding the Trust s control environment, covering the assurance framework, financial assurance and corporate assurance. It provided a Significant assurance except for rating, given the systems of control underpinning CIP delivery were new arrangements that were not yet embedded. The Committee noted the range of audits undertaken in and the positive engagement from the Trust regarding Internal Audit recommendations At its June 2016 meeting, the Committee received the Year End Annual Report from Internal Audit. This included an overview of internal audit work, quality improvements made to their service, their compliance with professional audit standards and the current status of outstanding high/medium risk audit recommendations made to the Trust. An update on audit reports issued since the previous meeting in March 2016 was also provided At the same meeting, the Committee reviewed the Internal Audit Plan and proposed work areas for This identified future audit work, by considering factors such as the assurance framework, risk register and Internal Audit s knowledge of the Trust, and was approved by the Committee At the December 2016 Committee meeting, Internal Audit reported that ransomware attacks were on the rise, and significantly so in public sector organisations. A briefing note was provided on managing such an occurrence. The Committee also received Audit South West s own Annual Report , which provided a summary of their priorities and activities in that year At the February 2017 Committee meeting, Internal Audit actions to address some slippage against their audit plan were noted, with the Head of Internal Audit Opinion forecast to remain in line with the final accounts timetable The Committee also received updates from Audit South West s Consortium Board. A report to the September 2016 Committee meeting covered the Consortium s on-going operation and day rates, and it was further reported to the December meeting that members had signed up to a rolling 3 year contract agreement with a 3 year notice period The Committee considered the major findings of Internal Audit and are assured that management have responded in an appropriate manner and that the Head of Internal Audit Opinion and annual Governance Statement reflect the circumstances of the Trust. 8. External audit 8.1. Throughout the year, the Trust received its external audit service from Grant Thornton UK LLP. They were engaged to provide this service from September 2012, for a 5 year period The Committee routinely received progress reports on the work of External Audit, providing it with assurance on internal control and financial reporting. These reports also comprised updates on emerging issues and developments, such as the impact of Brexit, development of Sustainability and Transformation Plans in the NHS and recovering the cost of NHS treatment for overseas patients. 5

9 8.3. At its May 2016 meeting, the Committee reviewed financial control related reports for the financial year ended 31st March 2016, including the audit findings report (incorporating value for money) and ISA260 report (communication of audit matters to those charged with governance). This was reported upon in last year s Annual Report on Audit Committee Activities in The Committee also agreed the fees and resources required by External Audit for The Quality Account is an annual report to the public from providers of NHS healthcare about the quality of services they deliver. At its June 2016 meeting, the Committee was advised of continuing work by External Audit in relation to the Trust s Quality Account and that so far no issues had been found. A report on the Quality Account was presented to the September 2016 meeting and proposed to issue an unqualified conclusion. This demonstrated an improvement from previous years The Annual Audit Letter covering was presented at the September 2016 meeting, summarising External Audit s approach (e.g. determination of materiality and risk levels) and key findings from its work in that financial year. This provided a recap on matters previously reported upon in more detail, such as the year end audit, ISA260 report and value for money conclusion. External audit gave an unqualified opinion on the Trust s financial statements and Quality Account for It was satisfied that the Trust put in place arrangements to ensure economy, efficiency and effectiveness in its use of resources, except for the arrangements for planning finances to support the sustainable delivery of strategic priorities and maintain statutory functions. It therefore qualified, on an except for basis, its value for money conclusion The External Audit plan for the financial year was presented to the February 2017 Committee meeting Following the year end, at the June 2017 Committee meeting, External Audit issued an unqualified opinion on the Trust s main financial statements for the year ended 31st March An emphasis of matter paragraph was included in its report to draw attention to the note explaining the basis on which the Trust had determined it was still a going concern. As in , it was satisfied that the Trust put in place arrangements to ensure economy, efficiency and effectiveness in its use of resources, except for the arrangements for planning finances to support the sustainable delivery of strategic priorities and maintain statutory functions. It therefore qualified, on an except for basis, its value for money conclusion The Committee ensured that External Audit recommendations made were addressed in a timely and appropriate manner. 9. Other assurance functions 9.1. The Committee s Terms of Reference allow it to gain relevant assurance from the work of other committees and other regulators/inspectors and this contributes to a coordinated approach to assurance arrangements within the Trust NHS Trusts are required to prepare annual reference costs in accordance with guidance published by Monitor. As part of Monitor s reference cost assurance programme, Trusts are audited every two years and, at its December 2016 meeting, the Committee noted the final audit report from PricewaterhouseCoopers regarding the Trust s reference costs. The Trust was rated as materially compliant and was continuing to improve its reference cost information prior to the forthcoming audit of its submission. 6

10 10. Management During the year, the Committee provided assurance to the Board that management were responding appropriately to internal and external audit reports and had put in place arrangements to strengthen internal controls The Committee requested and received assurance reports from management during the year. For example, a report to the December 2016 Committee on the benchmarking of losses and special payments, which found associated Trust spend as a proportion of total expenditure in was 0.07%, just above the average of 0.06% for the 11 Trusts being compared. Another report updating the Committee on actions to address clinical audit recommendations was received at its February 2017 meeting By receiving and debating such reports, the Committee has played a key role in raising the effectiveness of internal control arrangements and embedding robust arrangements for gathering, recording and monitoring sources of assurance for external assessment At its December 2016 meeting, the Committee approved the Annual Report on Audit Committee Activities in for presentation to the Board. 11. Financial reporting At its May 2016 meeting, the Committee reviewed and approved drafts of the full and summary Annual Report and Accounts for (including the annual Governance Statement), supporting documents and the proposed Letter of Representation. The experience and expertise provided by Committee members allowed for robust scrutiny and challenge of these documents and they were approved It was noted that the Trust was unable to meet its cumulative break even duty in , which had led to a referral by its external auditor to the Secretary of State for Health under section 30 of the Local Audit and Accountability Act 2014 (as also happened for the prior year). It was again decided that, on the grounds of materiality, the accounts of the charity would not be consolidated with the Trust s accounts Following this review, the Committee provided assurance to the Board that the financial statements had been properly prepared on a going concern basis, having received a detailed assessment of why a going concern basis was appropriate which included a supportive letter from the NHS Trust Development Authority (predecessor of NHS Improvement). The Committee recommended the full and summary statements and letter of representation for formal approval by the Board At its February 2017 meeting, the Committee was updated on key accounting issues for the financial year, approved the accounting policies and noted the year end timetable. There were no major accounting changes for , it was agreed not to consolidate the charitable fund accounts and it would remain appropriate to prepare accounts on a going concern basis. However, it was noted that the external auditor may issue a Section 30 referral to the Secretary of State, based on the Trust not achieving its break even duty. The Committee was also updated on the preparation of the Trust s annual Governance Statement. 7

11 12. Counter fraud The counter fraud service for the Trust is provided by Audit South West. Throughout , the Committee received regular updates on progress against the counter fraud work plan, the status of new and on-going investigations and any other pertinent issues about fraud. Work on raising general fraud awareness by Trust staff was regularly highlighted, along with instances of counter fraud advice given to staff on specific matters At its June 2016 meeting, the Committee received the Counter Fraud Annual Report for from the local counter fraud specialist. This provided the Committee with a summary of the Trust s anti-fraud activity during that operational year as well as assurance on its anti-fraud arrangements. An appendix to the report also showed the Trust had achieved its NHS Protect requirements At the same meeting, the Committee was advised that work on the National Fraud Initiative had been completed, leading to 82 creditors being de-activated on the financial management system, and preparations were underway for Trust participation in the exercise. An on-going annual leave review exercise had found staff to be taking leave in accordance with their entitlement At its September 2016 meeting, the Committee was advised that the annual leave review had been focussing on the calculation of leave entitlement and addressing some weaknesses found At its December 2016 meeting, the Committee was advised that as of NHS Protect would no longer provide training for counter fraud staff. This meant training and accreditation costs would impact existing budgets. It was also noted that NHS Protect and the independent charity Crimestoppers had jointly launched a dedicated 24 hour reporting line to tackle fraud, bribery and corruption against the health service in England and Wales At its February 2017 meeting, the Committee noted imminent receipt of the Self Review Tool for , an annual declaration of Trust compliance with NHS Protect s anti-crime standards that would need submitting by 1 st April The Committee also received and approved the draft counter fraud work plan for Auditor Panel An Auditor Panel was established by the Board following a change in the public audit regime requiring the Trust to appoint its external auditors. External auditors were previously appointed centrally by the Audit Commission, but the new system allowed each body to make its own appointment from an open and competitive market Updated Terms of Reference for the Auditor Panel s distinctive duties were approved and recommended for Board approval at the December 2016 meeting of the Audit & Risk Assurance Committee, with the Committee subsequently taking on the role of Auditor Panel to streamline governance and reporting issues The key duties of the Auditor Panel, as set out in its Terms of Reference, are to advise the Trust Board on the following: i. Selection and appointment of the external auditor; ii. Maintenance of an independent relationship with the appointed external auditor; 8

12 iii. iv. Where requested, whether or not any proposal from the external auditor to enter into a liability limitation agreement as part of the procurement process is fair and reasonable; and Any recommendation about the removal or resignation of the external auditor At its May 2016 meeting and in its capacity as Auditor Panel, the Committee noted that the Trust s external auditors were to be appointed through a market testing process. This would involve directly managing the resulting contract whilst maintaining the necessary independent relationship with the provider At its September 2016 meeting, the Auditor Panel agreed a proposal to recommend to the Board that an existing framework agreement is called off and the existing provider, Grant Thornton LLP, re-engaged for This would allow time for a joint procurement exercise within the county to be investigated, as well as align potential appointment timings with that of the council. Meanwhile, the re-engagement of Grant Thornton LLP for would mean operational continuity and proposed financial savings from fee levels, compared to At its December 2016 meeting, the Committee noted that the Council were receptive to a joint procurement exercise and were working with the Trust to address associated issues such as its governance and whether a joint auditor panel was required. Consideration was also to be given to structuring the tender to allow for individual procurement as well as joint procurement, should the bodies not agree on a provider In February 2017, the Committee was briefed on the requirement to have made an appointment by December Committee effectiveness Throughout , the Committee actively carried out its duty to provide the Board with assurance, or not, that effective internal control arrangements are in place. It regularly addressed the Board Assurance Framework, focussing on patient flow and capacity, and the Trust s Risk Register. Deep dives on some risks were commissioned, as previously referred to. 15. Cost/benefit analysis The direct costs of the Committee for the year ended 31 March 2017 were approximately 30,000. This includes the cost of internal and external audit attendance at the Committee, costs of members and the costs of Trust executive and support staff It is not possible to accurately quantify the benefits of the work of the Committee during the year as it is impossible to determine the financial impact of risks mitigated and costs avoided and the proportion of these that could be apportioned to the Committee s work The costs associated with loss of reputation should be mitigated as a result of the work performed by the Committee. 9

13 16. Other matters By receiving regular internal and external audit reports, the Committee has reviewed the processes and controls that the Trust has in place to meet its financial obligations throughout the year. It further notes that the Trust has achieved these financial obligations The Committee also continued to receive reports on losses and special payments, single tender actions, and endorsement of finance related policies in the year. At its February 2017 meeting, it discussed the donation of accumulated, unusable stock, identified as part of a stock amnesty and valued at 40,500, to a charity supporting overseas healthcare. A Deed of Gift document would be used, based on a national model document, to release the Trust from any future liability arising from the donated stocks. It was agreed that, subject to further assurances being sought from the Director of Finance, approval would be provided The Committee maintained open and professional relationships with the internal and external auditors, reserving time as necessary for any private discussions required. 17. Looking forward During , the Committee continues to focus on obtaining evidence to support assurances over controls covering the key risks faced by the Trust. The Committee will continue to actively follow up the matters arising from the reports that it receives and will advise the Board of any matters that have not been actioned satisfactorily The Committee will aim to continuously improve its processes for providing the Board with assurances that systems of integrated governance, risk management and internal control, covering all clinical and non-clinical Trust activities, remain fit for purpose and support the achievement of Trust objectives. 18. Conclusion The Committee has complied with its Terms of Reference during and is of the opinion that this annual report is consistent with the annual Governance Statement and Head of Internal Audit Opinion. There are no matters that the Committee is aware of at this time that have not been disclosed appropriately The Audit Committee exists to provide assurance to the Trust Board on key controls and aspects of governance across the organisation. This role remains significant in the Trust s challenging financial environment, and the Committee intends to maintain rigorous scrutiny. Margaret Schwarz Chair of the Audit & Risk Assurance Committee September

14 Summary Exception Report of the Finance Committee meeting minutes for 24 th July 2017 and 29 th August 2017 EXCEPTION REPORTS Name of Committee Chair of Committee Senior Officer Supporting Committee Finance Committee Dr John Lander, Non-Executive Director Sally May, Joint Chief Finance Officer Date Committee Held 24 th July and 29 th August 2017 Key Decisions and Matters Considered by the Committee 1. Month 3 and 4 Financial Position 2017/ The Committee received and reviewed the Month 3 finance report at its 24 th July meeting. The key headlines were as follows: The Trust s level income and expenditure was 0.2m better than plan for the year to date with a 3.5m deficit. Agency spend was under budget and totalled 762k in June, and improvement from 787k in May and below the 840k per month target. At Month 3 there was a 5.7m shortfall in CIP against the overall plan. Ongoing work was being undertaken to identify new CIP schemes. Capital spend was below plan. The Trust had received the STF cash relating to the previous year. 1.2 The key headlines from the 29 th August 2017 meeting and Month 4 financial performance were as follows: The savings gap remains a risk for the Trust. If further savings are not identified the Trust would report a deficit at the year end between 6.1 to 9m, and would also lose STF income. Agency spend had slightly increased in Month 4 but was still below plan. The Trust has 100k remaining from the 1m contingency allocated at the beginning of the year. 2. Savings Programme Month 3 and Month / The Trust has an annual savings target in 2017/18 of 17.3m. At the end of Month 3 the Trust delivered 2,158k against the target of 2,664k. The Committee challenged progress in a number of areas and noted that performance would be carefully monitored throughout the year. 2.2 At the 29 th August 2017 meeting it was noted that for the year to date at the end of Month 4 the Trust had delivered 3.4m against a target of 3.9m. The year end forecast position had improved by 1m but 1m of the CIP schemes remain red rated for delivery. 3. Contractual Performance Months 3 and Key headlines noted in Month 3 were as follows: 1

15 The contractual change regarding the recording of MIU activity (starting in July 2017) is now in place. ED growth increased in Month 3 with emergency arrivals up 4.3% compared to June RTT performance was at 92% in June. Delayed transfers of care reduced in June but remained at an average of 61 per day. Work continues with partners to plan for the use of the new social care money. 3.2 Key headlines noted in Month 4 were as follows: Contracts underperforming theatre and elective activity are the main areas of concern. Action is being progressed through the RTT meetings. Cancelled operations work is ongoing to implement improvements to scheduling patients to promote a better patient experience. DNA rates for the Trust are high. Outpatient rates will be addressed through the Outpatient Group. 4. Risk Assurance Report 4.1 The Committee received a report at its 24 th July 2017 meeting on the financial and commercial risks held on the Corporate Risk Register. It was noted that a review of the Trust s Risk Strategy would be undertaken with the aim of allowing more exposure to risks overseen by Committees as well as the Trust Board. 5. Shaping Our Future (SOF) 5.1 The Committee received a briefing on key aspects of progress of this programme. Work was ongoing regarding progressing the Accountable Care System, a system financial framework and back office schemes. Work was also in progress to bring business cases together, assess the impact of decisions and planning for next year. The second wave of engagement events had recently concluded. Capital bids were also being prepared to seek funding for various schemes /Out of Hours Project 6.1 At the 24 th July 2017 meeting the Committee review the contract/financial model and risks, whilst continuing to recognise the strategic benefits of this contract. 6.2 At the 29 th August 2017 meeting it was reported that the Trust was in the midst of operationalisation of the plan. Governance processes are being defined and will be shared once agreed. 7. Hotel Services Contract and Patient Care Improvement Plan 7.1 At the 24 th July 2017 meeting the Committee received an update on progress relating to the Hotel Services Contract noting that there had been no changes to the information previously provided. 7.2 At the 29 th August 2017 meeting improvements to services over the previous months were noted. There would be changes to Key Performance Indicators (KPIs) so that they were less complex for contract monitoring purposes. Following the mediation and negotiation processes, the terms of the proposed financial settlement was recommended for approval by the Trust Board. 8. E-Health Programme and Cornwall IT Service (CITS) Service Overview 8.1 The Committee received a report at its 24 th July 2017 meeting on key projects are services under the umbrella of Cornwall IT Services and the E Health Programme. Clinical Engagement in IT projects was noted, together with the benefits for patients from improved IT systems. 2

16 /17 Combined Costs Collection 10.1 At its 24 th July 2017 meeting the Committee received the Combined Costs Collection information which was produced annually. The Committee approved the 2016/17 combined cost collection submission. 10. Strategic Estates Partnership (SEP) Update 10.1 A report was received at the 24 th July 2017 meeting on options to progress work in the Trust. Options available to the Trust were discussed and the Trust would progress opting into a Project Phoenix Model which was being procured regionally (80/20 split). A regional Business Case was currently with the Treasury and, if approved, a procurement exercise would be undertaken. The Committee supported the establishment of the Phoenix model and partaking in the Regional consultation and development. 11. Tower Block Fire Safety Inspection Report 11.1 Following receipt of the Fire Safety Report at its June meeting, the Committee received additional information relating to a further review of the hospitals Tower Blocks with the aim of identifying any associated risks. The Committee accepted the contents of and recommendations of the report. 12. Key issues from Performance Review Meetings 12.1 At both meetings the Committee received reports providing key issues arising from the Divisional Performance Review meetings held, the contents of which were noted. 13. Cash Deep Dive Report 13.1 At its 29 th August 2017 meeting a Cash Deep Dive report was received. The Committee noted the cash management arrangements in place and the risks and mitigations to the cash balance, should the Trust s financial position deteriorate. 14. Briefing on Cornwall s initial STP system rating 14.1 On 29 th August 2017 the Committee received a report providing a briefing on Cornwall s initial STP system rating. The financial benefits from achieving integrated working as an STP around the receipt of capital monies, was noted. 15. Backlog Maintenance Sub Committee Update 16.1 At the 29 th August 2017 meeting the Committee received a report on the Backlog Maintenance Capital programme for 2017/18. The programme delivery position was noted and that there were no concerns about exceeding the budget allocation. Concerns identified and being managed at Committee/Sub Committee level Nothing specific. The Trust s Financial Position and the achievement of savings will continue to be monitored at each monthly meeting. Matters Requiring Board Consideration No specific issues to raise. Date of Next Meeting 25 th September

17 Summary Exception Report of the Quality Assurance Committee meeting minutes 8 August 2017 EXCEPTION REPORTS Name of Committee Chair of Committee Senior Officer Supporting Committee Quality Assurance Committee Jim McKenna, Chairman Thomas Lafferty, Director of Corporate Affairs Date Committee Held 8 August 2017 Key Decisions and Matters Considered by the Committee 1. Cardiology Update Matters Arising 1.1 The Committee sought further assurance through a routine report. 2. Surgical Care Improvement Plan 2.1 A comprehensive surgical plan centred on capacity and safety and culture was being produced which drew together all the pre-existing workstreams and would be presented to the October Committee. 3. Complaints External Review 3.1 The Committee noted the outcome of the review was expected imminently and the Committee would receive this at its September meeting. 4. Trust Incidents Report 4.1 The Committee received assurance that the serious incident management process was a top priority for the Trust and actions were being taken to improve the timescales of completing and responding to serious incidents. There was a further need for improved analysis and identification of themes and trends of complaints. 5. CQC Inspection: January 2017 Responsive Action Plan 5.1 A progress report was received which identified the ongonig actions outlined in the CQC January 2017 action plan. The July Hospital Inspection Report was scheduled to be received in September Committee Self-Assessment Evaluation 6.1 The Committee received the outcomes of the self-assessment survey which identified areas of weakness which included meeting governance and administration and the need for a stronger workplan. It was agreed to move to a monthly meeting. 7. Committee Sub-Group Reporting Arrangements 7.1 The Quality Assurance Committee Sub-Group reporting arrangements structure was last reviewed in 2016 where there were six sub-groups reporting directly to the committee. Two further sub-groups had been added and it was agreed that two sub- 1

18 groups would present reports at each meeting. 8. Clinical Governance Committee Report and TOR 8.1 The report highlighted that the Clinical Governance Committee were seeking assurances on the ongoing management of the Trust MRI scanners. 9. Information Governance Committee Report and TOR 9.1 The report highlighted that the Information Governance Committee had received reports on cyber security and the information governance toolkit, which was reported to be below the national target. 10. Divisional Performance Review Outcomes 10.1 The Committee received the report and it was agreed the format would be improved for clarity. 11. Integrated Performance Report 11.1 The Committee received the quality section of the IPR. Date of Next Meeting 26 September

19 People and Organisational Development Committee Exception Report to Board EXCEPTION REPORTS Name of Committee/Sub Committee Chair of Committee Senior Officer Supporting Committee People and Organisational Development Committee Sarah Pryce, Non Executive Director Catrin Asbrey, Director HR and OD Date Committee Held 18 th August 2017 Key Decisions and Matters Considered by the Committee Workforce Race Equality Scheme (WRES) The Committee received and discussed the updated WRES data for the organisation and the accompanying action plan. The dataset was agreed for publication on the Trust Website. Annual Equality Report 2016/17 The committee received a brief on the paper from the Equality and Inclusion Lead. It was agreed that the report could be put forward as an appendix to the Trust Annual Report should this be appropriate. Developing People and Improving Care the committee received a proposal to utilise the NHS I Cultural and Leadership Toolkit to underpin the development of the Trust leadership strategy. The proposal was agreed. Medical Revalidation Report the committee received the Medical Revalidation Report. The committee were left with unanswered assurance in relation to annual medical appraisal and requested additional work was undertaken and re-presented in October Staff Engagement the committee received assurance in relation to staff survey planning and the Q1 NHS Staff Friends and Family test. The committee noted the improving position and informed planning for the 2017 Staff Survey. Resourcing Update the committee received the Resourcing Paper and noted the current vacancy position. STP Update The Committee received the revised governance structure for the delivery of the workforce element of Shaping Our Future Professional Standards Report the committee received the bi monthly professional standards report. The committee requested correlation between grievances and bullying and harassment this will be presented to October Committee. Freedom to speak up the committee received a report regarding concerns raised through the Freedom to Speak Up Guardian and support officers. The committee resolved that this would remain a standing agenda item. Annual Committee Self Assessment the committee received and noted the outcome of the Committee Self Assessment. Concerns identified and being managed at Committee/Sub Committee level WRES further work to be undertaken in relation to recruitment data and continue to monitor the experiences of our minority ethnic staff in relation to bullying and harassment. Medical Appraisal - Additional work has been undertaken to strengthen assurance in relation to medical appraisal. 1

20 Matters Requiring Board/Committee Consideration The Board are required to sign off the annual statement of compliance for Medical Revalidation following additional assurance activity at September Trust Board Key Risks and Issues There are six workforce risks above tolerance, of which two are held on the Board Assurance Framework: Current Principal Risks 6214 There is a risk that the Trust does not have 'right people in the right place at the right time for the right cost'; posing a significant risk to the Trust's ability to meet its care obligations The Trust Staff Survey consistently highlights that there are low levels of staff engagement within the Trust levels of staff engagement are improving but remain lower than most other Trusts. This has the potential to adversely affect the delivery of transformational change and the day-to-day delivery of high quality and compassionate care Current Corporate Risks 5609 There is a risk that staff have inadequate annual mandatory training and do not receive an annual performance development review. This is caused by the inability to be released to undertake training due to operational pressures and the need to prioritise patient care. This could impact on the quality of patient care and patient experience There is a risk that the Trust cannot effectively drive the transformational change required as a result of insufficient leadership/change management capability/capacity from the Board to the ward. This would impact on the ability to change the embedded culture, put at risk delivery of the improvements required and adversely impact on compliance with the CQC 'Well Led' domain There is a risk that the culture that exists within maternity if not appropriately addressed could be detrimental to the Trusts reputation. Also impacting on the staff morale and patient care There are 4 vacancies in the Eldercare Senior Rota. Harm/Impact: Increased weekend rota intensity, increased number of Lieu days required mid-week, fewer consultants to cover the work plan. This will result in increased level of consultant sickness, risk to patient safety due to exhaustion when at work, increased number of delayed discharges due to lack of consultants to complete effective ward rounds. Lieu days required mid-week, fewer consultants to cover the work plan. This will result in increased level of consultant sickness, risk to patient safety due to exhaustion when at work, increased number of delayed discharges due to lack of consultants to complete effective ward rounds. 2

21 Date of Next Meeting Tuesday 17 th October 2017 Substantive Committee Business for the Next Meeting Freedom to Speak Up Strategy To Approve the Trust Freedom To Speak Up Strategy Research, Development and Innovation at Royal Cornwall Hospitals Trust To receive and approve the Annual report for 2016/17 Medical Revalidation Report To receive assurance on the revalidation process and compliance for medical staff Guardian of Safe Working Practice Quarterly Report To receive the quarterly report on safe working practices Resourcing Report To receive and discuss the current vacancy position and the mitigating activity underway. Health and Well-being Update To receive and discuss the implementation of the Health and Wellbeing Strategy Flu Campaign 2017/18 To receive and discuss the delivery of the Flu Campaign Action Plan Staff Engagement Update To receive an update on staff engagement activity underway. Health Education England Non-Medical Education Update To receive and discuss the performance of the Trust against the Learning and Development Agreement with Health Education England 3

22 EXCEPTION REPORTS Name of Committee Chair of Committee Provider Board RCHT and CFT Chairman Date Committee Held 9 August 2017 Key Decisions and Matters Considered by the Committee On Monday 9 August Royal Cornwall Hospitals NHS Trust and Cornwall Partnership NHS Foundation Trust held the third meeting of the Provider Board. The Board is a jointly held meeting of Chair, Chief Executives and Directors from each organisation. The Provider Board received a presentation on integration models and delivering improvement in quality and more efficient local services as well as organisational learning from other NHS Trusts. The Chief Executive of RCHT and CFT gave a high level summary of key issues which included the development of the STP, the recent CQC planned visit to RCHT in July 2017 and joint working relationships. The Provider Board received for information a Month 3 high level financial summary. The Provider Board received a workforce report which highlighted options around joint working and debate ensued regarding use of honorary contracts and the introduction of a framework. The Board explored the benefits and opportunities for integrated systems and processes. It was agreed that further exploration by the Joint Chief Financial Officer to enhance business intelligence and planning should be undertaken and reported back to the meeting. Improved engagement and integration with primary care was discussed and working closely with Kernow Health CIC and the LMC to secure their representation on the Provider Board. The Board agreed to receive an update (on a rotational basis) on the shared priorities and areas for closer collaboration: Urgent and Emergency Care to ensure the Emergency Department and Minor Injuries Units are more closely aligned); Onward Care for more effective discharge and homeward care; Frailty services for improved and more seamless care Stroke services for improved outcomes for patients; Rehabilitation services for improved pathways and integrated care after hospital; Children and young people services for more integrated care and support services. Date of Next Meeting 11 October