Scottish Ambulance Service Board Minutes of the Audit Committee Meeting held on Tuesday 15 June 2010 at 10.30 am in the Conference Room, National Headquarters Present: In Attendance: Doug Marr, Non-Executive Director (Chair) Andrew Richmond, Non-Executive Director Christine Humphries, Non-Executive Director Moi Ali, Non-Executive Director David Garbutt, Chairman Pauline Howie, Chief Executive Pamela Mclauchlan, Director of Finance and Logistics Cameron Revie, PriceWaterhouseCoopers Elizabeth Harper, PriceWaterhouseCoopers Paul McGinty, Deloitte LLP Gillian Connal, Deloitte LLP Sandra Nicol, Committee Secretary Doug Marr welcomed those present and introduced Moi Ali, who was attending her first Audit Committee meeting. He advised that Lesley Quirk, of Quirk Associates, who had attended the last meeting as an observer, had been very complementary about everyone involved in the Audit Committee. ITEM 1 MINUTES OF THE MEETING HELD ON 9 MARCH 2010 It was agreed that the minutes of the previous meeting should be accepted as a true and accurate record, subject to amending page 4, para 3 by removing the second clause in the sentence commencing The conclusion was ". The words after Forth Valley premises should be deleted. ITEM 2 MATTERS ARISING The action plan was reviewed and it was noted that the Internal Audit would report on their due action later in the agenda. ITEM 3 INTERNAL AUDIT (a) Internal Audit Status Report Paul McGinty advised that three reviews were being tabled today covering the last two pieces of work for 2009/10 and the first piece of work for 2010/11. No major risk areas had been identified. He reported that the Workforce Planning review had examined documentation and administration, with a few recommendations being made to improve the process. He commented that it had been a fairly clean
piece of work, with A ratings in terms of transactions tested. Referring to page 2, he advised that the outcome of the Secondary Employment investigation had been that the individual had been found to be undertaking additional work at times when he should have been working for the Service and had since resigned, which drew a line under it. Paul McGinty went on to point out that the overall activity summary on page 3 confirmed that the plan had been completed, although some areas had been deferred, for good reasons, into the subsequent year. Regarding the Review of NHS Partner Communications, he responded to a question from Christine Humphries in relation to synergy with quarterly clinical reviews and whether there was duplication of effort, by advising that Gillian Connal would be meeting with Daren Mochrie in South West Division to discuss and tie this up to avoid duplication. Christine Humphries said that she wanted to avoid activity that was unnecessary, commenting that NHS24 had a good framework. Doug Marr suggested they should ask the question Why are we doing this? in the first place. Gillian Connal said that significant work had been undertaken since the beginning of the year and the Scottish Ambulance Service had good engagement with NHS partners. Only four risk areas had been identified: two moderate; and two minor. These related to the need for standardisation of Divisional newsletters, agendas, Powerpoint and Word documents and updating the Communications Strategy to fully reflect recent progress and developments. Doug Marr queried why the opportunity to establish a standard newsletter was seen as a moderate risk, suggesting this was an opportunity rather than a risk. Gillian Connal replied that the risk would be the lack of consistency across the Divisions. Pauline Howie pointed out that the risk was explained further in the detailed findings on page 5 of the review; for example; the lack of clear messages, communications not being standardised, etc. Paul McGinty concluded that the risk should be more clearly defined. Action: Deloitte Pauline Howie said she had found this a very helpful report. There was an increasing need to be able to ensure Internal Audit were focussing on the appropriate areas for the Service and that their impact was measured and picked up in follow-up reviews. Paul McGinty advised that the Workforce Planning Review had identified five moderate risk areas, explaining that the Workforce Plan does not clearly demonstrate the links to underlying plans. He added that comparative reporting of statistical information should be gathered for the 2010/11 plan. Christine Humphries suggested they were missing the point in terms of how the description was framed, as it did not highlight the challenging nature of changes and big implications and risks for skills mixes. This was an opportunity to shift the way in which we format and describe what we do. She opined that the way the Service demand is being described should be moving more towards the case mix, patient requirements, and what that means in terms of skills mix. Pauline Howie said it should be a new way of working together for better patient care yet the review was looking back, not forward. David Garbutt responded to one of the findings - that the Workforce Plan had not being presented or approved by the 2
Board - by clarifying that the Board had actually made decisions and had more that just an oversight of the report, adding that this should be reflected. Paul McGinty agreed to amend accordingly. Action: Deloitte Paul McGinty reported that the Property Strategy Monitoring review had raised no issues. All transactions had been perfectly conducted, as normal, in accordance with the requirements of the NHS in Scotland Property Transactions Handbook. Pauline Howie said that their good work should be noted. (b) Internal Audit Annual report Paul McGinty gave a brief outline, highlighting some statistics on the work undertaken during the year on pages 3-6. He commented that the there was a consistent level of recommendations and was happy to report that the Annual Statement to the Audit Committee on page 7 confirmed their findings that the Service had an adequate framework of control in place. David Garbutt asked whether there was a summation of the Service having completed the recommended actions. Paul McGinty replied that this would generally be covered in the follow-up report rather than the annual report, although something could be done around that. Cameron Revie commented that there was a specific governance wording that should be included in the report. Pamela Mclauchlan suggested a few additional words could be included on the work that had been completed, adding that it might be appropriate to insert a table similar to that contained in the External Audit report. Cameron Revie stated that it should be consistent with other organisations under the governance of the Accountable Officer. Action: Deloitte ITEM 4 FOLLOW UP OF FLEET PROGRESS WITH AUDIT RECOMMENDATIONS Pamela Mclauchlan explained that a review had been carried out to establish whether the risks that had been identified by Internal Audit had been addressed. She advised that out of 11 risks, eight had been actioned by the end of March and that, in the view of Fleet Department, the remaining three could not be resolved until the new Fleet Management system comes into place at the end of the year. In the mean time, reviews would be undertaken quarterly by Internal Audit, independently of Fleet, in relation to these three risks. Andrew Richmond acknowledged that the new Fleet Management system would negate some of the risks. He suggested having a dedicated Stores Manager - a nominated individual - in place and Pamela replied that this was the case in Edinburgh only, adding that the new Fleet system was currently at the tendering stage. Andrew Richmond asked that the Board be provided with updates as part of the Finance Report. Action: Pamela Mclauchlan In relation to MoTs, Andrew Richmond asked whether the risk was that there was no assurance that they were being done on time. It was confirmed that this was the case; it had been a data entry issue and was now being addressed. Referring the page 4, he asked why parts would be entered when the price was not known. Pamela replied there were some instances of a part not being priced until it is used. Doug Marr suggested that these parts might be provided on a sale or return basis. 3
Pamela Mclauchlan confirmed that a small number of parts were only charged when they were actually fitted in a vehicle. Doug Marr said there were a lot of things still up the air and that the Audit Committee should be updated in three months time. Pauline Howie suggested that Fleet Services be invited to attend the next meeting. Pamela Mclauchlan advised that Internal Audit s Divisional Review in August would look at specific areas such as Fleet. Action: Pamela Mclauchlan Christine Humphries said the parts in question were specialist ambulance parts and prices could fluctuate substantially. She also suggested that some work might be required around making sure the insurance certificate and MoT for every vehicle could be tracked. Pauline Howie said there was a control issue around parts. Moi Ali asked if there was any monitoring of the cost of the parts, suggesting it would be interesting to compare whether the prices increased or decreased. Pamela Mclauchan said that some analysis could be undertaken. Doug Marr acknowledged that this was work in progress and Pauline Howie said the Committee would be cited on that at the next meeting. Action: Pamela Mclauchlan ITEM 5 EXTERNAL AUDIT (d) Annual Report to Members and Auditor General Cameron Revie said that this year they had been in a position to provide a written report rather than a presentation. He explained their responsibility to undertake the audit in accordance with the principles contained in the Audit Scotland Code of Practice and the co-ordinated approach that had been taken. Page 5 showed that the audit opinions were unqualified. Cameron Revie commented that the working papers they received were of a high standard and said this was very helpful. This was the first year of IFRS accounts and although there had been a lot of change and it had been a big commitment, it had gone very smoothly with no issues at all. There was nothing he would wish to report other than compliments. Page 6 gave assurance that any adjustments they had proposed had been processed and there were therefore no unadjusted misstatements to report. Regarding Accounting Issues, there were not many. The discount rate had been adjusted; however, this could not have been planned for, and the Scottish Government had agreed to fund it. Jim Dall said this could recur and was a concern going forward. After discussion regarding Asset Valuations, Cameron Revie agreed to review with Pamela Mclauchlan to provide more balanced wording. Action: PWC In relation to Creditors, it was queried why the number of creditor payment days had increased. Pamela Mclauchlan explained that the percentage is an average, and that invoices that are four years old drag the percentage down. This year s payments had improved and they were now in a situation where everything had been cleared up to January 2009. They were endeavouring to ensure that they were in the current year by the end of this year. Cameron Revie confirmed that the average number of days for the current year was 28 by value, or 30 by volume. He said that a 10 day target was aspirational and he did not know of any Health 4
Board that had that number. Andrew Richmond said that normal trading terms are 30 days. Doug Marr asked what our year-end target was in days and Pamela s response was 30 days. Regarding 2009/10 performance (page 9), Cameron Revie stated that the key message was that there was a financial surplus of 79k. Referring to pay costs, he said there had been a big improvement in overtime spend and that needed to continue throughout the year as this kept coming up as an overspend area. Andrew Richmond commented that an overspend of 495k was not significant as NHS Tayside had far larger overspends. Pauline Howie there were some cultural issues: a piece of work was going on to look at rostering and covering special events on overtime to assess whether we still want to be in that marketplace. The staff survey had highlighted the need for workforce planning to enable staff to maintain a work/life balance. Doug Marr reported that the Board wants to set a realistic target and get better value for money. Pamela Mclauchlan indicated that she would not want an organisation where it was acceptable to overspend on a budget line. The General Managers were fully aware of the importance of delivering a balanced budget at the year end. Resources must be utilised properly to get value from these resources. She did not think overtime could be banned as we are a 24/7 organisation; however, there was a need to ensure that overtime usage was appropriate. Cameron Revie said he would be interested to see how we establish our triage process. Pauline Howie said the Scottish Ambulance Service was aware of the issues that needed to be managed better. Doug Marr concurred that there was a necessary level of overtime and that we need to get best value from it. Turning to page 10, Cameron Revie stated that all three financial targets had been met. Out of 17 key performance targets, five had not been met. Christine Humphries commented that response times had nevertheless improved. Pauline Howie pointed out that it was the worst winter in 100 years and that should be reflected. Regarding A5 - PTS punctuality - Pauline Howie said this was reported quarterly and a figure for March could therefore be provided. Action: PWC Referring to Pay Modernisation, Cameron Revie said a lot of work would require to be carried out to meet the March 2011 target for e-ksf. Doug Marr agreed that we appeared to be slightly behind the plan. Pamela Mclauchlan explained that that particular target was measuring reviews; however a low percentage in the early part of the year was to be expected as this was before reviews were undertaken. David Garbutt asked what could be done to get the percentage up. Cameron Revie said he would look at the wording. Action: PWC It was agreed that sickness absence being behind target could be attributed to the severe winter weather. Cameron Revie went on to explain that at least one Best Value audit required to be undertaken per year, and the Scottish Ambulance Service had selected two specific toolkits for completion. Elizabeth Harper explained that the toolkits show 5
what stage each organisation is at, ie: advanced practices; better practices; basic practices or; does not meet basic requirements. (a) Best Value - Equalities Referring to the Equalities Risk Assessment, she advised that three medium and one low risk had been identified. Appendix A showed an Action Plan with recommendations. She expressed her thanks to staff for the effort made in getting the assessment completed. David Garbutt commented that we were moving to a single equality scheme, yet ours was not due for implementation until December 2011. He suggested that EQIAs should be implemented earlier. Pamela Mclauchlan replied that guidelines on the single equality scheme were expected to be issued by the Scottish Government later this year, and ours would be implemented after that. An initial assessment would be undertaken on EQIA and some policies as to their appropriateness and whether they would impact at all. Doug Marr agreed that once the statement comes out, timescales could be reassessed. Christine Humphries said that in terms of complaints, EQIA would be a very good test. Moi Ali expressed surprise that an equality impact assessment was not done for every policy. Pauline Howie replied that it would be considered; however, we want to make sure it is appropriate. Moi Ali said it should be recorded that we had thought about it. Regarding overtime, Christine Humphries suggested this was an opportunity to address some cultural issues. David Garbutt said it proved the value of the assessment tool. Pauline Howie concurred that we should be doing best value audits but questioned the relevance of it, expressing concern regarding future funding allocations to it. She said a more joined-up approach to audit was required, adding that it was not the best use of time and resources. Cameron Revie said he did not disagree. David Garbutt asked why this one was done and had we asked for it to be done. Pamela Mclauchlan replied that out of 18 toolkits on offer, about six had been appropriate. Equalities had been suggested because of the QIS report; it had been thought that this report would assist with that. (b) Best Value Resource and Planning Alignment With reference to the other Best Value audit - Planning and Resource Alignment Toolkit - Elizabeth Harper outlined the key themes that had been covered, ie does the organisation demonstrate effective strategic planning and resourcing; does it have a well-developed planning framework; and does its approach help deliver improved outcomes. She advised that three recommendations had been made - two medium and one low, again expressing her thanks to the staff involved. Regarding the Action Plan on page 9, Andrew Richmond asked about A.02. Pamela Mclauchlan responded by confirming that there was financial involvement with the programme boards and explaining that, at the end of March, the programme boards had only just been established and not all had met. In Appendix C, Item 1.3, David Garbutt queried the number of Executive members, pointing out that there were actually two Non-Executive members on each of the programme boards. Regarding how the budget is set, he said there was no 6
opportunity to plan because the budget figures were announced very late. Pauline Howie confirmed that risk assessment and estimating had to be applied. Pamela Mclauchlan commented that this was due to the financial environment in which we were operating and we were fully aware of it. Cameron Revie said that it was becoming more important to be very clear about priorities. Referring back to 5(d), the Annual Report on page 14, he said that having the permanent posts in place was a big step ahead and scoring well in the QIS review was good news as well. Nine new recommendations had been made but none were high. The table on page 15 showed the follow up on outstanding recommendations. Page 17 indicated that there would be tough times ahead. Cameron highlighted the six checkpoints on page 18 which might be relevant in addressing these challenges, of which he felt rigorous implementation to be the most important. Reference was made to the Audit Scotland Good Practice Checklist and Pamela Mclauchlan agreed to send this to David Garbutt. Action: Sandra Nicol Christine Humphries commended the work done by Scottish Ambulance Service staff and the audit team in preparing these reports. (c) Annual Accounts Pamela Mclauchlan explained that these had been prepared in accordance with IFRS standards and audited by External Audit. A number of typographical changes had been picked up and some additional information would be added. These revisions would be made before they were submitted to the full Board on 30 June. She highlighted the financial outturn showing that the year ended with a small surplus. Page 20 showed the Statement of Internal Control. The accounts would be signed by the Accountable Officer. Some minor corrections were agreed. David Garbutt queried the figures on page 51 and Pamela Mclauchlan explained that they were required to present the figures in this way. Doug Marr suggested that, although there was no choice regarding the presentation, some explanatory notes could be included to clarify. Cameron Revie replied that notes would draw attention to it. Pamela undertook to explain Note 6 to David Garbutt outwith the meeting. Action: Pamela Mclauchlan Pamela Mclauchlan expressed her thanks to External Audit. The process had gone exceptionally well this year. In view of a most significant change with public sector bodies moving to IFRS, it should be noted how smoothly the process had gone. She thanked the Finance staff, who had done a sterling job. It took a lot of work from the end of January to the end of June. She conveyed thanks of behalf of the Audit Committee, and Doug Marr commended the timeliness of it and added his thanks to External Audit. 7
ITEM 6 GOVERNANCE (a) Audit Committee Annual Report The report was approved subject to amending the table on page 3 by substituting n/a for dashes as appropriate. Action: Sandra Nicol (b) 2009/10 Notification to Heath Directorate Audit Committee After discussion, the letter to Kathleen Swift, notifying any significant issues or frauds considered to be of wider interest in 2009/10, was approved and it was agreed that Doug Marr would sign it. (c) Clinical Governance Annual Report Pamela Mclauchlan tabled the final version of the report, explaining that it had been received this morning and therefore there had been insufficient time to circulate it prior to the meeting. She highlighted the changes that had been made to the draft report and it was duly approved. (d) Staff Governance Annual Report The report was reviewed and it was established that Matt Bell would sign it. It was requested that, on page 3, the date when Christine Humphries left the committee should be checked. Action: Sandra Nicol (e) Audit Scotland Report - NHS Tayside FMS Pamela Mclauchlan advised that the report on Financial Management System (FMS) Computer Services 2009/10 had been circulated to all Boards using CEDAR and efin. She explained that the Scottish Ambulance Service was in a Consortium with NHS Tayside. A number of the actions on page 8 had already been undertaken and it was confirmed that staff would be taking forward the remaining actions. Christine Humphries asked about the risk in terms of a Manager. Pamela Mclauchlan replied that they had a Consortium Manager in place for 18 months and they were going through due process to develop the post. Funding on an annual basis for the support provided to us had been factored into the financial plan. Regarding Config 4, preparatory work had been undertaken, eg moving to a National Chart of Accounts, which had gone very smoothly. Pamela advised that the date when Config 4 would be brought it was still being debated. The requirement to close financial ledgers on the same day of the month was the most problematic issue; however agreement would no doubt be reached. (f) National IT Services Contract Scott-Moncrieff s lengthy report on the NHS National Services Scotland National IT Services Contract was reviewed. It was noted that page 5 showed the range of systems used. Page 13 highlighted the control exceptions that had been identified 8
and provided comment, which was duly noted. Doug Marr obtained agreement that the committee was happy to accept the assurances in this report. ITEM 7 FRAUD (a) Fraud Update Pamela Mclauchlan intimated that there were no current investigations and none awaiting prosecution. (b) Audit Scotland Report NFI in Scotland Pamela Mclauchlan explained that this was carried out on a two year cycle. The Scottish Ambulance Service had provided their update on time and the next update would be provided in September. There were no significant issues to report. Pamela advised that very few of the findings directly impacted on NHS Scotland Boards. ITEM 8 RISK MANAGEMENT Pamela Mclauchlan reported that the Risk Management Steering Group would be meeting later this week to review the Corporate Risk Register and that staff were working with NHS QIS to develop a standard set of risk KPIs for NHS Scotland. The register and graphs were reviewed and Christine Humphries commented that there were no surprises in the report and it was very good. ITEM 9 ANY OTHER BUSINESS There was none. 10 DATE AND TIME OF NEXT MEETING The next meeting has been scheduled for Wednesday 8 September at 10.30 am in the Conference Room, National Headquarters. 9