NHS Trust Development Authority Accountability Framework 2013/14

Transcription

1 Board meeting date: 24 th April 2013 Agenda Item number: 12.2 Enclosure: 13 Title NHS Trust Development Authority Accountability Framework 2013/14 Accountable Director: Author (name & title): M Ingram, Director of People and Corporate Development M Edwards, Interim Foundation Trust Project Manager Action required from the Board: Decision / Approval Gain assurance Discussion Information What other Trust Committee or Group has considered this report? Committee None Date reviewed Key points or recommendations Purpose of the report To inform the Board of the requirements set out in the recent NHS Trust Development Authority (NHS TDA) publication Delivering High Quality Care for Patients: The Accountability Framework for NHS Trust Boards. Summary of Key Issues and Risks for Board Attention The key issues that the Board needs to consider in this report are: The Accountability Framework provides a clear set of rules under which all NHS Trusts and the NHS TDA will operate, underpinned by clear principles to guide judgement on day-to-day decisions as well as long-term strategic ambitions. The report sets out how the expectations in the 2013/14 planning guidance will be delivered and how the NHS TDA will work with Trusts, in particular: how Trust Boards will be held to account

2 how the NHS TDA will assess the progress NHS Trusts are making towards FT status how the NHS TDA will provide the development support each organisation needs A report setting out the Trust s internal processes for delivery and accountability will be presented at the next meeting of the Trust Board in May. The key risks are: Until the Trust is authorised as a NHS Foundation Trust, it will be required to operate under the NHS TDA accountability framework. Recommendation(s) to Board To note the requirements of Delivering High Quality Care for Patients: The Accountability Framework for NHS Trust Boards To accept the recommendation to present the internal process and structure for delivery and accountability to the May Trust Board meeting. Strategic Objective(s) to which this paper relates: High quality services Inclusive partnerships Leadership culture Responsible workforce Supporting strategies Effective & efficient resources / Does this paper raise any Issues which are especially relevant to any of the following? Board Assurance Framework - Yes CQC Equality & Diversity Financial issues (revenue & capital) - Yes NHSLA OD/Workforce - Yes Patient safety & experience Patient & public involvement If so please explain in more detail The Accountability Framework sets out: Board Assurance Framework the way in which the NHS TDA will monitor risks and progress against all aspects of the Trust s Annual Plan for 2013/14. Financial issues (revenue & capital) the requirements for financial performance, sustainability and approval of capital investments.

3 OD/Workforce responsibilities for chair and non-executive appointments to NHS Trust Boards and Trust organisational governance and development.

4 Title NHS Trust Development Authority Accountability Framework 2013/14 Executive Summary In December 2012, the NHS TDA published the 2013/14 planning guidance for NHS Trust Boards - Towards High Quality, Sustainable Services. This set out the expectations of what needed to be delivered in the 2013/14 financial year and the medium to long term. Delivering High Quality Care for Patients: The Accountability Framework for NHS Trust Boards sets out how the expectations from the planning guidance will be delivered and the NHS TDA role. Context/Background The NHS TDA will oversee all aspects of a Trust Board s performance on delivering high quality care, including assessing and agreeing their overall plan for 2013/14 and monitoring progress on delivery on a day-to-day basis. The NHS TDA will also have the powers to support NHS Trusts to become sustainable organisations through approving transactions and significant capital investments, plus ensuring the right leadership is in place by making chair and non-executive appointments to NHS Trust Boards. The Framework sets out in detail three models: 1. Oversight model This reflects the requirements of the NHS Constitution, NHS Outcomes Framework, NHS Commissioning Board, CQC and Monitor license conditions and Risk Assessment Framework. Delivery will be assessed across 3 domains - Quality and Governance, Finance, and Delivering Sustainability - with a set of indicators identified for each domain. Indicators for Quality and Governance will be those set out in Monitor s draft Risk Assessment Framework (January 2013) plus additional NHS TDA indicators, and grouped in 5 categories: CQC concerns; access; outcomes; third party reports; and quality governance. Finance indicators will include: bottom line income and expenditure position; actual efficiency compared to plan split recurring/non-recurring; and forecast underlying revenue position compared to plan for the year. Delivering sustainability will assess a Trust s progress against the plan agreed with the NHS TDA to ensure future sustainability as a NHS FT or moving to another form.

5 2. Development model This seeks to provide support to organisations for addressing clinical quality issues, creating more patient centered services and improving organisational culture. Some support will be directly provided by the NHS TDA such as Clinical Faculty, access to benchmarking information, support for engagement activities and involvement and advice for director appointments and governance. Some support will be enabled by the NHS TDA such as NHS Leadership Academy, NHS Improving Quality (NHS IQ), NHS Interim Management and Support (IMAS) and NHS Intensive Support Teams (ISTs), and Clinical networks/senates. 3. Approvals model Builds on the DH Single Operating Model (SOM), bolstering assurance focus on quality and workforce and streamlining the middle assessment phase (previously SHA & DH phases) for FT applications and transactions. The NHS TDA FT process will comprise 3 stages leading up to the final Monitor phase: diagnosis and due diligence; development and application; and assurance and approval. The transactions assurance process for non-viable Trusts will consist of 4 defined sequential Gateways: trigger point; decision on procurement form; preferred solution; and implementation. The NHS TDA will also be responsible for approving significant capital schemes i.e. those over the value of 3% of turnover or 5million (whichever is the lower) and any Trusts proposals for service change/significant service improvements. Key issues/options available The NHS TDA will assess each Trust s level of risk to delivery based on a review of their Annual Plan submission, qualitative assessment of feedback from outgoing SHA, plus CQC and key financial indicators. This will determine their level of interaction with an organisation from the start of the year. The routine quality and governance indicators are set out in Appendix 1 of the Framework with new TDA indicators which are in addition to mandatory and Monitor s Risk Assessment indicators shown in blue. For Quality and Governance, Trusts will be rated monthly against each of the 5 categories listed above on a 5 point scale of escalating level of concern, from no identified concerns to formal action required.

6 Monthly returns are required to be signed off at Executive Director level and Boards expected to routinely seek assurance of data quality. Boards will be expected to self-certify against requirements focused around Monitor s license conditions and self-assess against a series of Board statements. The NHS TDA will aim to have a single conversation with Trusts encompassing quality, finance and progress towards a sustainable organisational form. Local Delivery and Development teams will lead a monthly integrated delivery meeting with each Trust s executive team to review progress against its operating plan, supported by a range of day-today interactions with the Trust. The NHS TDA will explore with Monitor the benefits of bringing together the BGAF, QGAF and HDD assessments both in terms of people, questions, and the benefits of triangulation into a common single external assessment process. In early 2013/14 financial year the DH will publish a national review containing recommendations about how service change should be delivered in the future. Guidance will then be issued by the NHS TDA on the approvals process for service change. A paper will be presented to the May Board outlining the Trust s internal process for delivery and accountability of the requirements in the framework. This will ensure integration with the performance framework and information flows to Board, following the Board and executive away days. Board action required It is recommended that the Board: 1. Notes the requirements of Delivering High Quality Care for Patients: The Accountability Framework for NHS Trust Boards 2. Accepts the recommendation to present the internal process and structure for delivery and accountability to the May Trust Board meeting.