GOVERNING BODY MEETING

Transcription

1 Enclosure: F genda item: 8 OVERNIN BODY MEETIN Title of paper: reenwich CC Recovery Plan Date of meeting: January 27 th 2016 Presented by: nnabel Burn Prepared by: nnabel Burn Title: Chief Officer & contact: annabel.burn@nhs.net Title: & contact: 1. To commission high quality, cost effective services to meet the needs of local people which improve health outcomes and reduce inequalities. 2. To ensure that the patients and the public s voice is heard so that we improve the quality of the services that we commission for the diverse needs of our population. 3. To develop reenwich CC as a clinically driven organisation with effective member engagement, that can attract and retain excellent staff, deliver effective governance and its X full statutory and financial duties. 4. To create and optimise a data and intelligence rich environment to inform commissioning X decisions at CC, Transformation Steering roup, Syndicate and practice level. 5. To develop a long term approach to improving healthcare and delivering more integrated services for the population of reenwich delivered by sustainable providers through x partnership working with RB, local providers, the community and voluntary sector. Please provide a summary of the paper being presented Purpose of the report: reenwich invited Deloitte to independently review the CC underlying financial position and run rate, the three-year financial recovery plan and to assess the robustness of assumptions and make recommendations for improvements to the ccountable Officer and the udit Committee Chair. This report responds to the recommendations in this report, identifies progress made and the need for further work to achieve financial recovery. Issues rising: The Deloitte report has been instrumental in focussing the organisation s attention to address the financial deficit. The Finance, Performance and QIPP Committee has also shown leadership to keep focussed on implementation. However at the end of January 2016 insufficient progress has been made to secure an improved outturn position in and a larger QIPP programme than planned is now required in While improvements in financial and corporate governance has been made and a stronger PMO approach adopted, the organisation is not yet able to demonstrate its capability to drive this larger QIPP programme successfully. Summary of ctions: Further steps are required urgently for reenwich CC to regain financial balance and the Chief Officer and Chair are meeting with NHS England to agree next steps. The Senior Management Team and P Executives are continuing to work with their teams to fully x

2 adopt the recommendations in the Recovery Plan and prepare a larger QIPP programme for Previous committee involvement: Finance Performance and QIPP Committee have considered the Recovery Plan and the udit Committee has received the full report and a summary of progress. Recommendations to the overning Body: 1. The overning Body is asked to note the contents of the report and actions being taken to recover the financial position of reenwich CC 2. Ensure that executive and assurance functions focus on the 4 key areas where the organisation needs to improve namely o Manage acute over-performance more effectively o Deliver QIPP programmes more consistently: for both 2015/16 and 2016/17 o Manage budgets more effectively not spending more money than we have o Build the capacity and capability to deliver this larger change programme (Please provide details below where Yes is indicated below) Impact on overning Body ssurance Framework (x) Yes X No N/ Impact on Environment (x) Yes No N/ X Legal Implications (x) Yes X No N/ Resource and or financial implications (x) Yes X No N/ Equality impact assessment (x) Yes No N/ X Privacy impact assessment (x) Yes No N/ X Impact on current NHS Outcomes Framework areas (x) Yes X No N/ Patient and Public Involvement (x) Yes No N/ X Communications and Engagement (x) Yes No N/ X Impact on CC Constitution (x) Yes X No N/ (i) (ii) ttachments: Paper Recovery plan tracker 2

3 Section 1: Background and Introduction 1.1.Background reenwich CC Recovery Plan January overning Body 2016 t the September 2015 overning Body the finance report stated:- The Budget Setting Framework approved at the June meeting of the overning Body set out the financial assumptions and expenditure plans supporting our Commissioning Plan 2015/16 and how we intend delivering our target surplus of 1%. Elements of the CC s financial plan were rated as not assured by NHSE citing following reasons: - the underlying position has deteriorated from surplus of 10.2m to an underlying deficit of 2.3m. Reasons for this include investment in the Better Care Fund, funding improvements in performance, agreement of block and cap and collar contracts. - Projections presented to NHSE have changed materially. ctivity and Performance plans have been assured. The CC has been assessed as an overall medium risk. overning Body Seminar was held on 19th ugust to consider the underlying position and proposed recovery plan in detail. The CC has invited Deloitte to independently review the CC underlying financial position and run rate, the three-year financial recovery plan and to assess the robustness of assumptions and make recommendations for improvements to the ccountable Officer and the udit Committee Chair. 1.2 Findings and recommendations in the Deloitte report The Deloitte team worked with reenwich CC and observed meetings, reviewed reports and plans and spoke to many people to form a view. They provided a detailed and comprehensive report to the chair of the audit committee at the end of September. This included useful feedback to the organisation including the following sections: 1

4 1.2.1 CC financial position and forecast (section 1) The 2015/16 non-recurrent forecast outturn in the adjusted base case is broadly consistent with CC expectations with a surplus of c. 3.3m (c.1.0%). Despite a number of activity pressures block and cap and collar contracts have enabled outturn risk to be largely mitigated allied to the use of unallocated reserves; The 2015/16 recurrent forecast outturn position in the adjusted base case has worsened from the CC plan of (2.6)m to (4.5)m due to the impact of unwinding cap and collar and block contracts to recognise greater levels of provider activity in acute and mental health sectors; The recurrent adjusted base case shows a (4.2)m deficit in 2016/17 and (0.6)m deficit in 2017/18 compared to the CC plan of (1.3)m deficit and 4.6m surplus respectively. This adjusted position differs from CC plan largely due to the compounding effect of activity pressure and higher growth assumptions. chieving the surplus position is reliant upon higher than historical levels of QIPP delivery. There is no scope for additional investment or cost pressures over and above those already planned in order to achieve this position. The non-recurrent adjusted base case shows a deficit of (4.1)m in 2016/17 and (6.1)m in 2017/18 compared to the CC plan of 3.6m surpluses in both years. This is worse than the recurrent position primarily due to the need to provide for 1.5% of contingency and transformation funds in line with business rules. lthough indicating a larger problem than previously indicated to the overning Body it concurred with the view that reenwich CC would meet its 1% surplus in This analysis has been updated and reported in the finance report and the project remains that the organisation will meet its targeted surplus. 2

5 1.2.2 Detailed recommendations for improvement (31) were including in the report and the executive summary included 7 overarching recommendations and the detailed plan links to this Recommendations In order to ensure returning to an underlying surplus position, we recommend a number of key actions are taken: We recommend the CC consider undertaking further analysis to understand the drivers of acute activity and it s future financial impact. nalysis to date has identified patterns and assumptions rather than directly linking cause and effect. Detailed analysis on the causes of an increasing conversion rate, for example, is likely to identify specific actions to reduce activity. In line with best practice, the CC should undertake a full exploration of the potential contract pressures and investment requirements in the local health economy over the medium term. This process will also help to identify the financial gap to [be] met through divestment and QIPP. The CC has begun to establish programme governance around QIPP. We recommend the CC increases the pace and urgency of implementing governance changes in order to focus on the development and delivery of QIPP schemes for 2016/17 and beyond. Utilising the nytown benchmarking and list of QIPP schemes we have provided, we recommend the CC triangulate our analysis with existing QIPP ideas in order to create an outline programme. We recommend the CC considers investing in additional capacity and capability in light of the plan to deliver higher levels of QIPP over the medium term. We recommend that a member with a financial background and qualification is appointed to relevant committees at the earliest opportunity. In line with best practice, financial information, such as the current, forecast and underlying position, should be effectively communicated through committee papers and given sufficient time and focus in these forums, in order to support decision making and early intervention where applicable. The full action plan is included in the appendix showing how each of these 7 with their supporting actions have been responded to. 1.3 reenwich CC response to recommendations reenwich CC B and the Finance, Performance and QIPP Committee have taken time out to review recommendations in depth. While accepting the detailed recommendations are required and supporting their implementation, the view of the Finance, Performance and QIPP Committee is that these actions are necessary but not sufficient on their own. This report responds to the Deloitte recommendations and identifies the progress made and the need for further work to achieve financial recovery. Section 2 reenwich CC response to recommendations 2.1 In December 2015 a progress report on the action plan was reviewed at the Finance, Performance and QIPP Committee. This outlined that whilst there had been significant progress against many of the specific and detailed Deloitte recommendations, the Committee was unable to get sufficient assurance that progress against the key objectives in the Recovery Plan had been made. The plan is very detailed and where there has been a lot of activity there now needed to be a greater focus on those actions that would have the greatest impact. These were summarised as follows and have been used to guide the focus of work across the organisation over the last 2 months:- 3

6 1. Manage acute over-performance more effectively 2. Deliver QIPP programmes more consistently: for both 2015/16 and 2016/17 3. Manage budgets more effectively not spending more money than we have 4. Build the capacity and capability to deliver this larger change programme The next section provides an update on each of these. Section 3 Progress against these major requirements 3.1 Manage acute over-performance more effectively number of very detailed reviews of activity have now been completed and the organisation can describe the changes that occurred in and are continuing in in detail. The level on non elective activity is the most significant change and has been focussed on most intently. This pathway includes all ages. The most significant change is the level of zero day length of stay activity. This was stable at around 81 admissions per month and not affected by changes in information systems. ctivity increased to an average of 168 admissions in the later part of 2014/15. In the new financial year (2015/16) this has increased to 216 admissions per month (an increase of 135 admissions per month). While some of the admissions will be necessary the pathway for these patients needs to be addressed as part of the contracting round in 2015/16 so that a more community focussed model can be implemented. This is part of the contract negotiations now taking place. Further work is being done along similar lines for planned care and maternity There is improved partnership working between reenwich CC and the CSU with enhanced sharing of business intelligence and data challenges being submitted to the acute providers more consistently. There is further work to do especially with providers other than Lewisham and reenwich Trust. The detailed work will inform contract negotiations for next year and also identify significant opportunities for QIPP programmes in the area of managing demand This work is being used to inform QIPP business cases and further work is required over the coming weeks to inform contract agreements. 3.2 Deliver QIPP programmes more consistently: for both 2015/16 and 2016/ QIPP delivery in is reported to the Finance, Performance & QIPP Committee and shows that the 5m QIPP identified in the Deloitte report can be released. However it is also noted that this represents significant underperformance the QIPP programme set out in reenwich CC s operating plan for and the shortfall financially is being covered from other sources of funds. Medicines management has delivered most of the required QIPP (albeit there risks in the last quarter of the year). Other programmes targeting non elective admissions, mostly funded by BCF may have been effective at individual project level but the overall contract is over performing. The discipline of monitoring QIPP programmes is still not fully embedded in the organisation. The PMO function was strengthened prior to Christmas and the new paperwork for programme management (Train Tracks) is being adopted more systematically now. 4

7 3.2.2 Planning 2016/17 QIPP The annual planning process is progressing using the Deloitte recommendations for QIPP and other benchmarking tools and these programmes are being driven by the newly established adults and children commissioning groups. The in- house team commissioning team has been enhanced with a small team from ttain (a QIPP-delivery focused commissioning support organisation). The goal was to develop a QIPP programme of circa 9m with a 13.5m stretch target recognising that schemes tend to be delayed or under deliver. So far the programme has been developed to circa 9m with programmes at various stages of the business case development. The programme is made up from a mixture of transactional savings (decommissioning or releasing efficiencies within the organisation) and higher risk transformation plans. further 2m of schemes have been identified as in the pipeline and work is taking place to bring these to full business case/. The gap of 2m to be found is also being identified. The financial settlement for CCs was issued recently and early indications are that with this allocation and the outturn anticipated in that the full 13.5m programme will need to be delivered in for the CC to remain on track as set out by the Deloitte report in September. Therefore building the capability to deliver the larger QIPP programme is a high priority. 3.3 Manage budgets more effectively not spending more money than we have The finance team has been working with directors and their teams to review spend and alignment of spend against budgets. Some opportunities for savings have been identified and a tighter discipline has been adopted to ensure that spend is in line with budgets. Where significant overspends have been identified recovery plans are being put in place and for the largest one of these (CHC) the PMO function is tracking progress There is greater clarity across the organisation of the use of non recurrent sources of funds and the implication of using these in the short term Many of the recommendations in the comprehensive report have been adopted and these can be reviewed in the tracker in the appendix of the report. The Finance, Performance and QIPP Committee has also given feedback to the finance team on the quality of reports provided which have been enhanced in the last months. 3.4 Building the capacity and capability to deliver this larger change programme The Transformation and Delivery Directorate restructure last summer and has been recruiting to substantive posts. Some progress has been made with strong candidates being appointed to the Head of Children s Services, Head of Primary Care and the Executive ssistant to the Director. Other posts have not been appointed to including the D Delivery which is a critical role in the CC. There continues to be some absence through sick leave and the D Transformation has recently left creating a further vacancy Through HR, a tracker has been developed for each post in the management structure and a project management approach is being taken to ensure that each of these is filled. Increasingly applicants are being required to work their full period of notice in other NHS organisations which is 3 months creating a delay in the new capacity being in place. 5

8 Therefore the full recruitment process takes 4-6 months and where interview panels do not appoint, even longer. This leaves the organisation relying too heavily on the senior management team and interims. Section 4 Conclusion and recommendations 4.1 The Deloitte report has been instrumental in focussing the organisation s attention to address the financial deficit. The Finance, Performance and QIPP Committee has also shown leadership to keep focussed on implementation. 4.2 However at the end of January 2016 insufficient progress has been made to secure an improved outturn position in and a larger QIPP programme than planned is now required in While improvements in financial and corporate governance has been made and a stronger PMO approach adopted, the organisation is not yet able to demonstrate its capability to drive this larger QIPP programme successfully. 4.3 Further steps are required urgently for reenwich CC to regain financial balance and the Chief Officer and Chair are meeting with NHS England to agree next steps. 4.4 The Senior Management Team and P Executives are continuing to work with their teams to fully adopt the recommendations in the Recovery Plan and prepare a larger QIPP programme for nnabel Burn Chief Officer, NHS reenwich CC 6

9 CTION PLN RISIN FROM THE FINNCIL REVIEW PROVIDED BY DELOITTES - OCTOBER UPDTE DECEMBER 2015 Target Recommendation ctions Lead Director Date 1. Undertake further analysis to understand drivers of acute activity, its future financial impact, and action plan to reduce activity. Progress/comments R E Recommendation 1.1 Undertake further analysis to understand the drivers of acute activity and its future financial impact (e.g. analysis of causes of an increasing conversion rate). Work with Public Health, CSU and informatics to obtain regular and timely analysis to feed into overning Body and Commissioning meetings Internal discussion required on how to make this work in practice. IF Report from CSU considered at reenwich Executive in September & November 15 giving an overview highlighting changes in acute activity. Detailed report on non elective admissions completed early January and informing contract negotiation and activity planning for Clinical input to reviewing non elective pathway taking place dditional data challenges have been actioned by CSU at LT (should be an outcome by end of January) Draw on analysis to shape QIPP programmes and contract negotiations for Report progress to Commissioniong reenwich Executive February 3rd Review remit of both CSU and CC informatics teams to ensure CC has robust analytics available in a clear and consistent manner (all options should be considered). Specification of what is required to be developed Option appraisal on different options gree what data is used for baselines; SUS vs. MR and reconcile these. IF Further work still needed to clarify role and remit of CC and CSU informatics functions and whether the right capacity is available. Teams working together well. Working model on data sets being developed for the contracting round R Specific plan of actoin required to resolve this issue 2. Identify clearly the financial gap that needs to be met through disinvestment and QIPP. 2.1 Ensure more robust financial planning and analysis and reporting of schemes, and their phasing. Finance to be integral in the development and costing of Commissioning Intentions. Training to be made available to staff to support this, if required. dditional capacity in finance required CSR due end of November. IF/SJ Finance and informatics team sit on weekly recovery meeting and are much more closely linked. Links have been made to south east London programme assumptions and the CSU more embedded. Next steps on this are to instigate additional training and support for teams, utilising experience with CC and ttain Specific actions have been taken but further embedding work to be done. Continue to monitor progress through

10 2.2 Undertake a full exploration of the potential contract pressures and investment requirements in the local health economy over the medium term. This process will also help to identify the financial gap to be met through disinvestment and QIPP. Set up process through the development of commissioning intentions and contract negotiation. Run a workshop exploring the impact on 16/17 budgets Set up group to oversee 16/17 budget chaired by CFO to include CSU and local informatics. IF Progress has been made in this area with budgets being validated. This has highlighted many issues with coding against specific budgets and further work is required. The allocations were issued late and budget setting workshops have not yet been run. Progress to be monitored through Commissioning E 3. Establish programme governance around QIPP with pace and urgency. 3.1 Standardise and strengthen QIPP risk reporting and ensure mitigations are properly documented and reported. Ensure project leads escalate risks within 48 hours or via QIPP meetings. overnance changes to be implemented. DJ 02-Dec Complete: Risk register amended to reflect QIPP position 15/16-16/17 (30/10/15). Risks will be reviewed at QIPP executive meeting. Complete: Need to ensure risks reflected across suite of reports to overning Body and Committees. Close dd delivery R ratings to QIPP and BCF schemes. Ensure robust KPIs are used including using non financial KPIs to assess performance. Set up a QIPP Steering roup (this is QIPP and Programme Executive) and ensure that there are clear processes for identifying and prioritising QIPP opportunities. Establish regular use of scenario planning to support good decision making in particular this should include financial scenarios with sensitivity analysis. Establish and agree a timetable of critical dates for the QIPP programme and ensure this is communicated internally. Establish clinical, project and executive ownership of each QIPP scheme to ensure escalation channels are clearly defined and used effectively. Finance and performance to work together to agree methodology To be reported under new governance. Ensure all QIPP schemes have clear outcomes and KPIs. Performance to work with Commissioning and Delivery to ensure this is delivered by 31/12/15. overnance changes to be implemented. Build into the development of commissioning intentions and strategy planning. CC diary planner and use of technology to increase communication Timetable discussed as part of EMT meetings. overnance changes to be implemented. SH 30-Nov ll new QIPP schemes are risk rated and QPE ensuring this is monitored Close B 30-Nov Progress on tracking in year QIPP limited. R B/RP (co Chair) SH/IF/ SJ SH/SJ B 30-Nov 02-Dec 02-Dec Complete - change of joint chair to nnabel Burn, CO Terms of Reference written and 1st meeting took place on 30/10/15 with monthly meetings held since and scheduled for the rest of the year. n external consultant with a financial planning background was recruited and started 26/10/15. New interim CFO in place. Work underway to ensure scenario planning. In overning Body Paper for January 2016 ll meetings set up via new PMO function. QIPP Recovery roup is held weekly led by Director of Commissioning, Delivery and Transformation. Seminar held for Clinical Commissioners on their role as commissioners, business planning and traintracks etc. Paper to E 6/1/16 outlining process linked to new strategy and financial plan. ll meetings set up, Traintrack procedures implemented and new clinical/exec leads agreed. Strengthened PMO function is operational PMO to ensure that process is in place for months 11 & 12 QPE reports to reenwich Executive who will monitor. Close action. Further work to be completed on financial modelling of QIPP schemes. Commisisoning E to monitor progress in February Monitor through reenwich Executive - close action Monitor through reenwich Executive - close action

11 3.8 Establish a value threshold for QIPP schemes to ensure that time and resources are not expended on schemes with limited financial benefit. QPE to review each Business Case. greement to establish a Star Chamber approach prior to QPE to ensure schemes appropriate with respect to finance and management resource required. B 30-Nov Embedded in process for 2016/17 and operated by new PMO Close 3.9 Consolidate and risk adjust the BCF schemes (i.e. make them real and clearly understood as to their relationship to QIPP and the organisation s business). Decide how to report both internally and up to NHS England in a more meaningful manner. 2016/17 BCF refresh provides an opportunity to review and evaluate all schemes Establish internal BCF reporting. SH BCF Steering roup established. Monitoring information provided as requested by NHSE. Work commenced on measuring risk. Further work with RB is required to consolidate and risk adjust schemes which has not been finalised. Work will be complete by end January 2016 which then needs to be agreed for with RB through the Joint Commissioning Committee and HWB Establish a QIPP tracker scheme. QIPP tracker started B 30-Nov Limited progress on tracking in year QIPP delivery. Tracking of QIPP programme in place. R Formalise the PMO structure, and ensure that it is understood and used across the organisation. Ensure it is properly and adequately resourced (it is a 13m QIPP programme). Increase the pace and urgency of implementing governance changes for QIPP programme management in order to focus on development and delivery of QIPP in 2016/17 and beyond. overnance changes to be implemented Supported by communication and training. Move to new ways of working immediately supported by communications across the CC overnance changes to be implemented 4. Create an outline 2016/17 QIPP programme using nytown benchmarking and Deloitte analysis Triangulate Deloitte analysis with existing QIPP ideas in order to create a more robust outline programme for 2016/17 and beyond. Undertake an assessment of all the potential future schemes identified by Deloitte with a view to including in revised commissioning intentions (Nov ov Body). Set up process through the development of commissioning intentions and contract negotiation Use of external capacity to accelerate progress Develop roadmap to set out deadline for 16/17 QIPP plan. Set up process through the development of commissioning intentions and contract negotiation Use of external capacity to accelerate progress Develop roadmap to set out deadline for 16/17 QIPP plan. B SH SJ SJ with SH 30-Nov 5. Invest in additional capacity and capability in light of the plan to deliver higher levels of QIPP over medium term. 5.1 ddress skills gaps within the staff team through structured training. gree organisation requirements Identify gaps for each function/team member Support development through PDPs. SH ongoing PMO moved into direct control of CO. New senior appointment being made 14th December with weekly QIPP recovery meetings and tracking of QIPP programme in place. Traintracks documentation is being used. Steering groups and QPE set up and have met. QPE leading on this with PMO support. Roadmap for QIPP development in place. dditional resources secured to assess the anytown benchmarking as well as looking for additional opportunities. Progress made but QIPP programme for 16/17 is not large enough and more detailed plans and assurance is required. Roadmap in place Workshop with held 2/12 ttain commenced. Still not sufficient progress to 13m QIPP target. Commenced the rowing success programme, including a series of workshops to address a general skills gap. Training approval process published and courses available listed on new intranet. Interim arrangements put in place to strengthen team and cover gaps R R Refresh for next year to be completed by March 2016 PMO to prioritise development of in year QIPP tracker by the end of January Close prioritise devleopment of QIPP programme through weekly recovery meetings s above Focus on recruitment to substantive posts and monitor through reenwich Executive

12 5.2 ddress skills gaps within the clinical commissioning team and overning Body. Improved programme of CPL induction, with clarity on roles and supervision by overning Body members Clarity around role and function of Syndicate Leads. greement on overning Body member portfolios. SH ongoing P executives have new portfolios aligned to strategic programmes of CC and have met Chair to agree priorities and clarify role. Further work to do to align P Execs and managers. CPLs appointed and work plans in place. B development day 24 February More work needed with respect to staff development and over reliance on interims Focus on recruitment to substantive posts and monitor through reenwich Executive 5.3 Undertake an assessment of the level of staff sickness and vacancies; ensure this is reported to the SMT regularly. Set up an HR Tracker looking at staff sickness and staff vacancies, SH (with HR) 09-Dec Report to January reenwich Executive highlighting areas of further work. For SMT early January reenwich Executive 5.4 Invest in additional capacity and capability in light of the plan to delivery higher levels of QIPP over the medium term. This applies to finance, delivery and the PMO in particular. Invest in additional capacity and capability in light of the plan to delivery higher levels of QIPP over the medium term. This applies to finance, delivery and the PMO in particular. Continuously review requirement for additional capacity and capability across all functions to deliver this action plan and enable delivery into the future. 6. ppoint a member with a financial background and qualification to the udit Committee. 6.1 ppoint a member with a financial background and qualification to the udit Committee at the earliest opportunity. (JW has already stepped down as udit Chair, and will become associate lay member of B). dverts to be placed for appropriately qualified members. B/SH 28-Feb DJ New interim CFO appointed and started in November SUbstantive appointment to be made using headhunter. 7. Improve transparency of financial information in committee papers, ensuring sufficient challenge is able to be given by members of committees/overning Body Improve level and type of financial information in To include : committee papers in order to support decision making. This should include consistent - Financial and activity analysis by provider - BCF investment and return - QIPP investment and delivery. reporting of QIPP delivery at Committee which includes analysis and commentary. Statement of Financial Position to include comparators to previous month end and previous financial year and position. Establish a checking mechanism in Finance for all figures in reports in line with Deloitte recommendations on page 62 (errors). Finance reports to be amended to include. Senior finance team member not involved in the preparation of the report to carry out the check. Formally approved by CFO. IF 30-Nov ttain providing support to develop QIPP for 2016/17 (appointed November 2015). Substantive appointments have been made to some post but increasingly staff are having to work full 3 months notice to be released so continued use of interims and agency staff required. New strengthened PMO from December Project management approach now being taken to move from interims to substantive staff and monitored the weekly recovery meeting ppointment not made through initial recruitment process. Further candidates being sources. lternatives to enhance the audit commttee being considered to oversee end of the financial year reater transparency in reports with further work to do. IF 30-Nov Complete. IF 30-Nov Complete. R Monitor through reenwich Executive Escalated to CO Continute to

13 Be clear which information on finance and performance should be presented to, udit and to ov Body (end practice of using the same report differentiate depending on role of meeting). Improve note taking and minuting of committee meetings. Ensure Chair of meeting plays an active role in agreeing minutes and agenda in advance of meeting taking place Use Executive Summaries of Committee/B reports more effectively (provide training to report writers to enable this to happen). Make clear how financial risks in report relate to CC s risk register. Ensure that risk management process is reviewed for its robustness in relation to financial risk management. Meeting to be arranged with relevant Directors and chairs to agree level of information for each meeting based on good governance practice. Review training needs for minute taking and for the chairing of meetings. Training to be put in place, with example summaries. Review of CC risk management to ensure its robustness, ensuring appropriate risks are reported to the correct level of governance. Establish a single version of the truth so that reporting is understood by all relevant overnance changes to be implemented parties and reported consistently Weekly SMT discussion. to all committees/forums (using PMO structure). Re-establish combined performance and finance reports but with meaningful cross references. Ensure that financial matters are given sufficient prominence in committee meetings. This to be considered with reference to all papers going to governance committees to ensure consistency and avoid duplication. genda planning to ensure adequate time and prominence is given for discussion Meeting chairs to ensure discussion time at meetings. IF/SH DJ DJ DJ/IF SH SH/IF DJ/SH 02-Dec 14-Dec 02-Dec 02-Dec 02-Dec 30-Nov In progress. Revised report completed for and well received. workshop 2 December. Need to ensure embedded for this committee cycle. Plan to arrange appropriate training available to support chairs will be addressed at the B development session 24 February. Minute takers training planned for January Two people have already attended. Minute takers given time to write up minutes and send to the chair within 5 working days of the meeting. This has slipped to February 2016 Complete: Individual support given to report writers. Cover sheet revised and step guide provided. Staff use of report template has improved. Risk management policy agreed by E. Risk management strategy on governing body agenda. Risk register has been amended to reflect financial position. Risk register discussed at and updated as required. Workshop 2 December completed a review of risk register's ratings. New PMO set up and working. New business case format being used. In progress but not delivered in November. Discussed at and it was agreed to include activity and review how quality, performance and finance are to be reported across the CC. Will be implemented for January 2016 Committee cycle. Complete genda planning changed and set out timeframe for agenda 2 weeks before meeting date. Continute to monitor throug Change target date to 20 January 2016.