Title of Paper: Good Governance Outcomes Maturity Matrix assessment report and action plan

Transcription

1 Item Number: 127 GOVERNING BODY MEETING Meeting Date: 22 November 2016 Report s Sponsoring Governing Body Member: Philip Hewitson, Lay Member for Audit and Governance Report Author: Sally Brown, Associate Director of Corporate Affairs. Title of Paper: Good Governance Outcomes Maturity Matrix assessment report and action plan 1. Strategic Objectives supported by this paper: To create a viable & sustainable organisation, whilst facilitating the development of a different, more innovative culture To commission high quality services which will improve the health & wellbeing of the people in Scarborough & Ryedale To build strong effective relationships with all stakeholders and deliver through effectively engaging with our partners To support people within the local community by enabling a system of choice & integrated care To deliver against all national & local priorities incl QIPP and work within our financial resources 2. Executive Summary: The Audit and Governance Committee members meet annually to review the effectiveness of the committee, review the feedback from the committee survey, assess progress against the governance matrix, and identify any areas of development and training for members. The maturity matrix helps CCGs assess where their performance is against best practice The Audit and Governance Committee members met on 30 September 2016 and as part of their work completed a self assessment of where they felt the CCG was on the maturity matrix. The attached report shows the self assessment and action plan for Oct Sep 2017 to progress along the matrix. 3. Risks relating to proposals in this paper: None identified 4. Summary of any finance / resource implications: None identified. 5. Any statutory / regulatory / legal / NHS Constitution implications: Each year the CCG is required to publish an Annual Report and Accounts and included in the report is the Head of Internal Audit opinion. The process adopted by the Audit and Governance Committee in the annual self assessment demonstrates a culture of continuous improvement. 6. Equality Impact Assessment: Page 1 Our Vision to Improve the Health & Wellbeing of our Communities

2 N/A 7. Any related work with stakeholders or communications plan: Representatives from Internal Audit and CCG officers attended the workshop and the action plan highlights the need for a review of communication and engagement with member practices and GPs. 8. Recommendations / Action Required The Governing Body is asked to: a. Review the Self assessment report b. Approve the action plan for Oct Sep Assurance The Audit and Governance Committee will monitor progress against the plan and report to the Governing Body through the Chair s quarterly written report.. For further information please contact: Name: Sally Brown Title: Associate Director Of Corporate Affairs : Page 2 Our Vision to Improve the Health & Wellbeing of our Communities

3 Good governance outcomes for CCGs: A maturity matrix to support development and improvement Reviewed and rated by A&G Committee, October 2016 Progress Levels Key elements 0 No 1.BASIC LEVEL Principle accepted and com m itment to action 2. EARLY PROGRESS Early progres s in development 3.RESULTS Initial achievem ents evident 4. MATURITY Res ults cons istently achieved 5. EXEMPLAR Others learning from ourcons istent achievem ents CCG Score by A&G Committee members. Oct 2016 CLARITY OF PURPOSE as a membership organisation, values and strength of uniting vis ion, including s setting tone at the top, leading by example, living the values etc 1 purpose and vision articulated in CCG documentation, and has been formally agreed Know ledge of purpose and vision by governing body and others in leadership roles Most of membership able to articulate vision and purpose. Decisions consistent with vision. Objectives strategy and business plans are consistent with mission and vision External stakeholders recognise distinctive CCG approach and understand aims. CCG can identify examples of w here purpose has been delivered CCG vision has influenced partner organisations 3.5 LEADERSHIP & STRATEGIC DIRECTION understanding of market and context, balance between operational demands and strategic goals and creating a pipeline of clinical leaders for the future 2 CCG leadership has been identified and strategic goals agreed and published. Governing body members are clear on their roles, both individually and as part of a group, on the governing body The governing body is focusing on reaching the strategic goals and are using instruments such as the assurance framework to deliver these. Plans to motivate clinical leaders of the future have been agreed. Business I operational plans are in place, and reflect marketplace context and strategic goals The membership and key stakeholders agree that the CCG leadership are working towards achieving the strategic goals. Clinicians new to leadership roles are involved in CCG business Strategic goals are starting to be achieved. CCG membership agrees that CCG leadership has added value to achieving CCG goals. Succession plans f or clinical leaders in operation The CCG is starting to change the local health and social care system by achieving its goals, and this is recognised by partner organisations 3.0 EFFECTIVENESS OF RELATIONSHIPS And co-operative behaviours MEMBERSHIP SUPPORT And unity. Member owners hip of CCG PUBLIC AND COMMUNITY ENGAGEMENT Including openness and transparency QUALITY AND SAFETY STRUCTURES AND SYSTEMS including mechanisms to gather patients and carer experience data, adoption of best practice, com m itment to research, investment in development, holding each other to account professionally etc. 3 The CCG has articulated the key relationships and behaviours internally and externally that w ill help deliver the CCG goals 4 Membership participates in voting, member activities, and attends membership f orums 5 The CCG has agreed w ith the public and local community w ays they can be involved 6 The CCG has identif ied the improvements to service quality and saf ety it w ishes to make. CCG plans value research and the development of clinical prof essionals both amongst CCG members and in local providers The CCG's working approach can be characterised as thoughtful about the quality of relationships internally and with key partners Members generally engaged in CCG business and participate at various levels in decision-making. Members comply w ith decisions and policies agreed by the CCG Public involvement in CCG work is evident, such as community view is being used as part of the evidencebase f or decisions. The CCG has agreed approaches to transparently reporting issues to the public. Public and community engagement in decisions is real and has impact CCG decisions and operational plans can be linked to f ormal CCG structures and systems to improve care standards in line with the evidence-base. Systems are in place that enable the CCG to deliver its duty of care, including saf eguarding There is early evidence that local providers, partner organisations, and other stakeholders recognise an ef fective working relationship, supported by an appropriate set of behaviours Members conf ident that CCG is achieving change and reaching some goals. Members f eel CCG business is their business Members of the public involved in CCG decisions, such as via HealthWatch or w within patient participation groups. Members agree that they have been material to some CCG decisions CCG decisions and operational plans can be linked to f ormal CCG structures and systems to improve care standards in line with the evidence-base. New responsibilities such as collaborative commissioning have been f ormalised. Systems are in place that enable the CCG to deliver its duty of care, including saf eguarding Local providers, partner organisations, and other stakeholders agree that the CCG is materially influencing their plans and performance. CCG contribution valued by partners Members agree they contribute to their CCG performance and consider their CCG model better than alternatives. Competition f or leadership places Leaders in the CCG value community input as a source of insight that helps make better decisions. CCG is able to demonstrate that public/community engagement has led to change. Engagement methods in line w with sound social science practice Clinical audits within primary care and in providers are showing that local practice delivers care to accepted standards of practice. Agreed care pathways are being followed Ef fective working relationships with local providers, partner organisations, and other stakeholders are seen as a key element of the successful achievement of goals f or all Constructive participation with CCG business by membership is the norm. Membership understands and recognises the rationale f or their CCG's decisions The local community are advocates f or the w ways in w which the CCG is working 2.0 Comparative audits demonstrate practice in the local healthcare economy is in the upper quartile (in terms of following accepted evidence-based practice, and adhering to agreed care pathways). A collaborative approach across the health and social care economy to drive quality is evident 3.5

4 FOCUS ON OUTCOMES understanding what matters to improve health of population, driving quality and safety, codesign with service users, coordination of care 7 Desired improvement in outcomes agreed, and good baseline data used by key players in CCG Processes connected to benef icial outcomes identified and included in CCG operational plans Identifiable changes in referral patterns towards operational goals. Early signs of desired process changes taking place. Patient and carer experience positive outcomes Measurable improvements in metrics related to better outcomes and reported patient experience Early signs of shif t in indicators of population health 3.0 BETTER DECSION-MAKING development of KPls, us e of information, data integrity, and ongoing audit etc. used to support sound decisions, mature management of conflict of interest CONTROL SYSTEMS both outwards and inwards - e.g. clarity of external authority and expectation, risk appetite, internal assurance on resources and quality, effectiveness of governance structures, quality of challenge etc 8 The CCG has agreed how it w ill make decisions, and this includes using evidence and reliable data as the f oundation to making sound decisions 9 The CCG is authorised w ithout conditions. The essential architecture of good governance and quality/performance I f inancial systems are in place, and an agreed operating model is in place Matters f or decision by the CCG are supported by evidence and data. Matters f or decision are supported by clear, high-quality papers, and discussions clearly involve considering the evidence Control and assurance systems are starting to routinely identify outlier behaviours and rectify these. Instruments such as the assurance f ramework and risk register are known and understood by governing body members. Internal audit reports and opinions are acted upon There is a consensus amongst the membership and stakeholders that CCG decisions have been thoughtfully made and are f air. Evidence has been used when decisions are made. Conf lict of interest issues routinely recognised and managed The governing body members agree that the governance mechanisms in place are usef ul and reliable. Performance data and system recognised as f it f or purpose by the governing body. These mechanisms are f elt to have contributed to the good running of the CCG CCG is conf ident that its decisions are robust and could not be overturned or changed as a result of poor process. Stakeholders are conf ident that conf lict of interest issues are appropriately managed Members consider the CCG to be a w ellgoverned organisation, and value the governance mechanisms that are in place, such as the election processes to the governing body and approaches to resource distribution. The CCG's audit committee are conf ident that the CCG's control and assurance systems are f it f or purpose other stakeholders consider that CCG decisions are f air and sound. The CCG sets the standard that other organisations f ollow other stakeholders are conf ident with the CCG's governance and performance Approaches LEGAL AND REGULATOR COMPLIANCE fulfilling statutory and other duties such as the duty of candour 10 The governing body members are aw are of their legal duties and CCG plans ref lect achieving these CCG discussions can be shown to relate to the legal duties of the CCG. Governing Body business ref lects delivering the NHS constitution CCG performance reports and review s of operations show progress towards goals relating to legal duties, such as equalities,integration and quality of care other stakeholders understand the CCG's legal duties and would agree that these are being discharged other stakeholders value the CCG as delivering on its statutory duties ORGANISATIONAL EFFECTIVENESS les s repetition, great re ource management, effective procurement, best us e of com m issioning support, fewer divers ions arising from governance failures, etc. 11 Plans in place f or developing organisational ef f ectiveness Examples of better working practices being adopted. Routine review of governance mechanisms agreed. Personal development plans agreed f or key staf f and governing body members Governing body has reviewed its ow n practices and made improvements to its work. Staf f and clinical leader development planning, including appraisals, is the norm Internal stakeholders are conf ident of organisational ef f ectiveness. External review s of governance/organisational ef f ectiveness Benchmarking of management ef f ectiveness e.g. management costs I numbers of managers I % of management time provided by clinicians exceeds comparators

5 ACTION PLAN for Oct Sep 2017 Progress Levels Key elements CLARITY OF PURPOSE as a membership organisation, values and strength of uniting vision, including s setting tone at the top, leading by example, living the values etc No 1 CCG Score by A&G Committee members. Oct 2016 Target Score by October ACTIONS Develop an engagement plan to work more closely with member practices so that they better understand the challenges of the CCG. The plan will include: - Practice visits bi- annually to discuss: a) variations in referrals and secondary care service and b) delivery of primary care services to support transformation plans including GP Forward View. - Continue to deliver training and education events through Protected Time for Learning LEAD GOVERNING BODY MEMBER AH/RM WHEN Q4 LEADERSHIP & STRATEGIC DIRECTION understanding of market and context, balance between operational demands and strategic goals and creating a pipeline of clinical leaders for the future EFFECTIVENESS OF RELATIONSHIPS And co-operative behaviours Re introduce the stakeholder newsletter which presents the STP and GP Forward View plans in summary format. Revisit the engagement plans with practices and identify how best the strategic plans can be shared with primary care members. Review how more GPs and primary care staff can be involved in CCG projects. Implement the newly ( August 2016) Communication and Engagement Strategy. Develop an approach of consulting with groups of GPs early in the service redesign process complimenting the quarterly CoCR meetings where CCG plans are shared. AH PG Q1 Q4 MEMBERSHIP SUPPORT And unity. Member owners hip of CCG Review the report from the CCG survey and identify areas for improvement in CoCR engagement. AH Q4 PUBLIC AND COMMUNITY ENGAGEMENT Including openness and transparency Continue to deliver the communication and engagement activities which reflect the Customer Service Excellence framework. Communicate and engage earlier in the development of plans by sharing the challenges faced by health care service commissioners and providers. AH ongoing QUALITY AND SAFETY 6 STRUCTURES AND SYSTEMS including mechanisms to gather patients and carer experience data, adoption of best practice, commitment to research, investment in development, holding each other to account professionally etc Governing Body to formally adopt the Research and Development Strategy and continue to develop a CCG plan to increase the number of practices/patients participating in research projects. Continue to strengthen Governing Body lead role with officer support in line with SLA. Quality and Performance Committee to receive Research and Development progress reports. Governing Body to continue to review Quarterly Clinical Report which proves assurance on processes in place to monitor clinical quality and safety and patients and carer s experience through Family and Friends Test. IW/CW Q3

6 FOCUS ON OUTCOMES understanding what matters to improve health of population, driving quality and safety, codesign with service users, co- ordination of care BETTER DECSION-MAKING development of KPls, use of information, data integrity, and ongoing audit etc. used to support sound decisions, mature management of conflict of interest Although we have an understanding of the demographics of the population the CCG will continue to work with partner organisations to redesign services, improve access to, and measure outcomes of services which aim to improve health. As part of Ambitions for Health, the CCG will promote self care and prevention of disease, in particular reducing smoking rates, reducing obesity levels and improve access to mental health services at an earlier stage. Implement in full the new CCG policy of the management of conflicts and audit the effectiveness of the systems and processes. Ensure all service specifications include contract KPIs and where national targets are not set agree local targets to demonstrate year on year improvement. PH Q3 PG Q4 CONTROL SYSTEMS both outwards and inwards - e.g. clarity of external authority and expectation, risk appetite, internal assurance on resources and quality, effectiveness of governance structures, quality of challenge etc Implement the terms of reference for the new Joint Commissioning Committees and audit the effectiveness of the committees in particular compliance with the CCG scheme of delegation. The Governing Body to agree and record the risk appetite against corporate risks. Where authority is delegated, ensure appropriate measures are in place to manage risk. SC Q4 LEGAL AND REGULATOR COMPLIANCE fulfilling statutory and other duties such as the duty of candour Further develop the assurance framework to ensure appropriate measures are in place to fulfill the statutory and other duties and report these in the CCG Annual Report. PH Q1 ORGANISATIONAL EFFECTIVENESS less repetition, great resource management, effective procurement, best us e of com missioning support, fewer divers ions arising from governance failures, etc Continue with commissioning support embed contract review meetings and implement formal escalation process when service failures are not resolved. Continually review the effectiveness of time allocation to internal and external meetings to avoid duplication. RM ongoing