Paper 15 Ayrshire and Arran NHS Board Monday 19 May 2014 Performance Governance Committee Annual Report for 2013-14 Author: Helen Strainger-Boyce, Performance Manager / Frances Ewan, Planning and Performance Assistant Sponsoring Director: Dr Allan Gunning, Director for Strategic Planning, Policy and Performance Date: 2 May 2014 Recommendation The Board is asked to agree the Annual Report as an accurate reflection of the work of the Performance Governance Committee during 2013/14. Summary The Health and Performance Governance Committee (H&PGC) was established by the NHS Board on 27 July 2005. Following a review of the governance structures, new governance arrangements were agreed at the NHS Ayrshire & Arran Board meeting in December 2012 which saw the inaugural meeting of the newly structured Performance Governance Committee (PGC) take place on 4 March 2013. Members of the PGC are appointed annually by the NHS Board. The NHS Board also requires input to the work of the PGC by Executive Directors. This PGC annual report provides a record of attendance at meetings and gives assurance that the committee has fulfilled its remit Key Messages: The Committee focused on high risk areas in relation to Health, Efficiency, Access, Treatment (HEAT) targets and access as well as routine financial performance reporting; The Committee also selected areas for more indepth analysis including the Integration of Health and Social Care. Glossary of Terms H&PGC PGC HEAT Health and Performance Governance Committee Performance Governance Committee Health, Efficiency, Access, Treatment 1 of 11
MRSA MSSA CAMHS PSG MRG CRG LDP AMU HIS Meticillin-resistant staphylococcus aureusis Methicillin-sensitive Staphylococcus aureus Child and Adolescent Mental Health Services Pay and Supplies Group Medicines Resource Group Clinical Resource Group Local Delivery Plan Ayrshire Maternity Unit Healthcare Improvement Scotland Monitoring Form Policy/Strategy Implications Workforce Implications Financial Implications Consultation (including Professional Committees) Risk Assessment Best Value The activities of the Committee refer directly to key areas of accountability for the Board including the Local Delivery Plan, Annual Review and HEAT targets. These are included in key documents such as the Local Delivery Plan which the Committee scrutinises. These are included in key documents such as the Local Delivery Plan as well as routine financial reports which the Committee scrutinises. Performance Governance Committee members have been consulted in the preparation of this report. Cororate risks allocated to the Committee are reviewed on an ongoing basis and the Committee applies a risk approach in selecting areas for more indepth analysis. - Vision and leadership - Effective partnerships - Governance and accountability - Use of resources - Performance management Following review, the Health and Performance Governance Committee and Finance Committee have been merged to form a new Performance Governance Committee. This will ensure a coherent approach in line with best value principles. Compliance with Corporate Objectives Single Outcome Agreement (SOA) Help support delivery of national and local objectives. Close links between many HEAT targets and SOA priorities including delayed discharges. Impact Assessment This document is an internal document and no impact assessment has been conducted. 2 of 11
NHS Ayrshire and Arran Performance Governance Committee Annual Report 2013/14 1. Introduction 1.1 The Health and Performance Governance Committee (H&PGC) was established by the NHS Board on 27 July 2005. Following a review of the governance structures, new governance arrangements were agreed at the NHS Ayrshire & Arran Board meeting in December 2012 which saw the inaugural meeting of the newly structured Performance Governance Committee (PGC) take place on 4 March 2013. Members of the PGC are appointed annually by the NHS Board. The NHS Board also requires input to the work of the PGC by Executive Directors. This PGC annual report provides a record of attendance at meetings and gives assurance that the committee has fulfilled its remit. Membership in 2013/14 is detailed in section 3 below. 2. Remit This constitutes the first annual report of the PGC. 2.1 The Committee s Terms of Reference are detailed at Appendix 1 to this report. 3. Membership 3.1 Membership of the PGC during 2013/14 was as follows: Dr Martin Cheyne, Chair Chairman Mr John Burns Chief Executive Mr John Callaghan Employee Director Mrs Susan Dunn, Non-Executive Member (until 30 September 2013) Dr Allan Gunning, Director for Strategic Planning, Policy and Performance Cllr Hugh Hunter, Non-Executive Member Mr Derek Lindsay, Executive Director Finance Mr Robert Martin, Non-Executive Member (from 1 November 2013) Mr Stephen McKenzie, Non-Executive Member Ms Gillian Watson, Non-Executive Member (until 30 April 2013) Mr Ian Welsh, Non-Executive Member Where relevant to the subject matter, other officers attended meetings of the Committee. 4. Meeting 3 of 11
4.1 The Committee met on 4 occasions between 1 April 2013 and 31 March 2014. Dates are as follows: 3 June 2013; 23 September 2013; and 13 January 2014; 10 March 2014. 4.2 The NHS Board agreed in 2010 that attendance at Committee meetings should be recorded in the relevant Annual Report. The attendance record of each member is shown below. x indicates attendance n/a indicates not applicable. 3 June 2013 23 Sept 2013 13 Jan 2014 10 March 2014 Dr Martin Cheyne (chair) x x - x Mr John Burns x x x x Mr John Callaghan x x x - Ms Susan Dunn x - n/a n/a Dr Allan Gunning x x x x Cllr Hugh Hunter x x - x Mr Derek Lindsay x x x x Mr Stephen McKenzie x x x x Cllr Ian Welsh x x x (chair) x Mr Robert Martin n/a n/a x x 4 of 11
5. Committee Activities 5.1 Routine Performance Reports HEAT HEAT performance reports were presented to the Committee as a standing agenda item. Scrutiny of the routine reports received by the Committee, including performance against the HEAT targets and standards as well as delivery of the Waiting Times targets continued to be a key area of responsibility of the PGC. Areas of poor or worsening performance were discussed in detail at the meetings of the Committee with key staff members from the areas in question. The Committee was also keenly aware of direction of travel against high risk areas of performance within the HEAT suite of targets and in particular against the standards. Main areas for discussion were as follows: MRSA/MSSA; Clostridium Difficile; Drug and Alcohol Referral to Treatment; Faster Access to CAMHS/Psychological Therapies; Rate of attendance at Accident & Emergency; Breastfeeding; and Sickness Absence. In particular, the issue of staff sickness absence remained an area of concern for the Committee who were reassured of the increased focus by the service and by the Staff Governance Committee. Following discussion, the Committee agreed that consideration of escalation to the Board would be taken forward through the Staff Governance Committee. The Committee was also made aware of initiatives undertaken by the CAMHS service, including commissioning an external review in order to identify recommended measures to be implemented. This included using additional funding to appoint a Facilitator and Data Analyst. A position statement by the CAMHS service was considered by the Committee at the 3 June 2013 meeting, with a further progress report provided to the 23 September 2013 meeting and the 10 March 2014 meeting. Routine Financial Reporting Throughout the course of the year, the committee was provided with a range of financial information for consideration. This included at their 3 June 2013 meeting: Timetable for 2014/15 budget setting process; Medium Term Financial and Savings plan; and Waiting Times Non-recurring spend and budget. At the 23 September 2013 meeting, a further six financial reports were provided on: Locum/Agency spend; 5 of 11
Financial Management report for the period to 31 July 2013; Use of Non-recurring Resources; Medium Term Financial and Savings plan; Future Pension Costs; and Health and Social Care Integration Budgets. At the Performance Governance Committee meeting on 13 January 2014, financial reports were provided in the following areas: Financial Management report for 8 months ended 30 November 2013; Prior Commitments 2014-15; Rare Conditions Medicines Fund; and Summary of Cost Pressures, Funding Available and Required Efficiency Savings. As well as considering the Financial Management Report to 31 January 2014, the 10 March 2014 Performance Governance Committee meeting considered detailed papers on the 2014/15 budget. Pay and Supplies Group (PSG); Medicines Resource Group (MRG); Clinical Resource Group (CRG); Clinical Staffing; Summary of Cost Pressures, Allocation Available and Efficiency Savings. 5.2 The Performance Governance Committee plays an important role in the capital approvals process and during the year approved a Standard Business Case, an addendum to an Outline Business Case and two major Full Business Cases. Endoscopy Decontamination Standard Business Case; Outline Business Case for the Future Delivery of Front Door Services: Following due consideration, Committee approved the outline business case addendum and asked the team to proceed accordingly; Building For Better Care: Full Business Case: The Full Business Case put before Committee related to funding of the new Emergency Department at Ayr Hospital and Combined Assessment Units at both Ayr and Crosshouse Hospitals; Full Business Case for the Acute Mental Health and North Ayrshire Community Hospital. 5.3 Providing Assurance on other Performance/Governance Activities The Committee discussed a range of other areas where assurance was required on governance across NHS Ayrshire & Arran. These were: Annual Review: This had taken place on 7 August 2013 and its subsequent letter outlining the actions for the Board was presented to the Committee; Mid year Review: This took place on 24 January 2014; 6 of 11
Local Delivery Plan 2014-15: At the meeting on 10 March 2014 the Committee discussed the draft for submission of the LDP 2014-15; Maternity Strategy 2011-2017 update: The Maternity Quality Improvement Group was co-ordinating clinical improvement with improvement packages being developed and tested, including the Ayrshire Maternity Unit (AMU) Safety Brief. It was also highlighted that Community Services had received Baby Friendly accreditation; The Committee were made aware of the recent positive Healthcare Improvement Scotland (HIS) visit to the AMU as part of the Quality Collaborative and the strong improvement culture that had developed within this unit. The Committee were encouraged by this progress and recognised the achievements of the staff involved; Nurse Staffing: Various changes in the landscape in recent years partly owing to new treatment time guarantees, had resulted in the need to review the nursing workforce requirements within Ayrshire and Arran. There had also been a significant increase in the use of supplementary staffing which needed to be addressed. A plan outlining the key indicators and details of reductions in the use of agency and bank staff would be submitted to CMT; Transfer of Healthcare for People in Police Custody: Committee noted the progress and real challenges and risks associated with this transfer; Our Health 2020 : A Health and Wellbeing Framework for Ayrshire and Arran: At the 13 January meeting, Committee considered the latest version of the Our Health 2020 document which had been amended following discussion at the Board Workshop on 16 December 2013 and subsequently endorsed by the Corporate Management Team. Following approval by Committee, the document would be presented to the Board on 3 February 2014; Integration Health and Social Care: The Committee considered progress on Integration throughout the course of the year covering for example: o Implications of national finance guidance and associated accountability arrangements; o Recruitment of Chief Officer posts; o Transition and Shadow Integration Boards; o Health Integration Steering Group; o Joint meeting of Chief Executives / Strategic Alliance; o GP engagement events; and o Updates on timescales for the Bill amendments. 6. Chairs Comments 6.1 I am grateful to all members of the Committee for their support in the development of the agenda and for the considerable work undertaken during the year. During the course of 2013/14, the Committee covered a wide range of activity relating to the governance of performance. As well as reports in areas such as HEAT standards 7 of 11
and targets and Finance, the Committee also scrutinised specific issues in more detail, asking for further information and assurance as is required as part of their remit. I can confirm that the Performance Governance Committee has fulfilled its remit and that the Board has adequate and effective governance arrangements in place. I would wish to record my thanks to all the staff who have supported the Committee over this and previous years, in both the current and previous governance structure, and to those who have responded to requests from the Committee for further information. This has enabled the Committee to fulfil its duties successfully throughout the past year. 8 of 11
Appendix 1 Terms of Reference 1. Introduction PERFORMANCE COMMITTEE 1.1 The Performance Committee is identified as a Committee of the NHS Board. The approved terms of reference and information on the composition and frequency of the Committee will be considered as an integral part of the Standing Orders. 1.2 The Committee will be known as the Performance Committee of the NHS Board and will be a Standing Committee of the Board. 2. Remit 2.1 To provide assurance to the NHS Ayrshire and Arran Board that systems and procedures are in place to monitor, manage and improve overall performance and best value is achieved from resources. 3. Committee Membership 3.1 The Committee shall be established by the full NHS Board and be composed of six Non-Executive Members, the Chief Executive, Executive Director of Policy, Planning and Performance and Executive Director of Finance. The Chair, Vice- Chair and Committee will be appointed by the Chair of the NHS Board. 3.2 Committee membership will be reviewed at least annually. 4. Quorum 4.1 Three Non-Executive members and two Executive Directors will constitute a quorum. 5. Attendance 5.1 Chairs of Sub-Committees will be in attendance at the Performance Committee to report on the work of the sub-committee. The Committee may establish Sub- Committees to support its functions. 5.2 The Committee may co-opt additional advisors as required. 5.3 With the prior approval of the Chair of the Performance Committee the Executive Director of Policy, Planning and Performance and the Executive Director of Finance will be able to provide deputies on an exceptional basis. 9 of 11
6. Frequency of Meetings 6.1 The Committee will normally meet bi-monthly, but will meet at least four times per annum. 6.2 The Chairperson may, at any time, convene additional meetings of the Committee. 7. Authority 7.1 Committee is authorised to investigate any matters which fall within its Terms of Reference and obtain external professional advice. 7.2 Committee is authorised to seek and obtain any information it requires from any employee, whilst taking account of policy and legal rights and responsibilities. 7.3 The Committee will have the authority to require the attendance of any employee of NHS Ayrshire and Arran, as may be required. 8. Duties 8.1 To scrutinise the overall performance of NHS Ayrshire and Arran across the following functions of the NHS Board: Resource allocation; Performance management; Strategic planning. 8.2 To ensure that systems and procedures are in place to monitor, manage and improve performance, across the whole system, and liaise closely with relevant Governance Committees (Staff, Clinical and Audit) to ensure appropriate remedial action takes place. 8.3 Consider financial plans and approve annual budget proposals and business cases for submission to the NHS Board. 8.4 The Performance Committee would consider: HEAT/Local Delivery Plan Investment Scrutiny Benefits Realisation Post Project Evaluation Finance and Service Performance 8.5 To support the development of a performance management and accountability culture across NHS Ayrshire and Arran. 8.6 Receive annual reports and quarterly updates from the Sub-committees established by the Performance Committee in order to provide assurance and accountability. 8.7 To monitor and review risks falling within its remit. 10 of 11
9. Conduct of Meetings 9.1 Meetings of the Committee will be called by the Committee Chair. 9.2 The agenda and supporting papers will be sent to members at least five working days before the date of the meeting. 10. Reporting 10.1 Minutes will be kept of the proceedings of the Committee. These will be circulated, in draft normally within five working days to the Chair of the Committee and within five working days thereafter to members, prior to consideration at a subsequent meeting of the Committee. 10.2 The Chair of Committee shall provide assurance on the work of the Committee and the draft minutes will be submitted to the NHS Board meeting for information. 10.3 Items requiring urgent attention by the NHS Board can be raised at any time at NHS Board Meetings, subject to the approval of the Chair. 11 of 11