Service Transformation TERMS OF REFERENCE Trust Board decision to set up the STC January 2010 Date of this version September 2011 This version prepared by Lynn Hill Director of Operations & Transformation Terms of Reference approval by Trust Board December 2011 Review Date: September 2012 Service Transformation Terms of Reference September 2011 1
1. Purpose The purpose of the Service Transformation is to support the Trust s Assurance Framework through monitoring the establishment of detailed plans and delivery of the service transformation plan and cost improvement programme. This relates to assurance both that initiatives that have been implemented are being achieved in line with plan and that initiatives proposed to be implemented have robust and deliverable plans in place. This is of particular significance during the procurement phase of the proposed redevelopment project as the sustainability of the Trust s redevelopment plans are dependent on the delivery of the service transformation plan and cost improvement programme. In addition to monitoring progress, the will provide guidance on priorities and will have responsibility for providing all the necessary Executive support to ensure the programme succeeds. 2. Establishment of the Service Transformation The is a non-executive committee of the Board and has no executive powers, other than those specifically delegated in these Terms of Reference. The is established in accordance with the Trust s Standing Orders, Standing Financial Instructions and Scheme of Delegation. 3. Authority and accountability The reports to the RNOH Performance and Trust Board through reporting the work of the committee from each meeting for information and approval. 4. Duties The duties of the are as follows: 1. Monitor the service transformation plan and CIP key performance indicators and agree the detailed reporting arrangements that will be needed to gain assurance on delivery. Summary milestones and associated key performance indicators are attached. (see Annex 1) 2. Seek assurance that that the work of the individual cost improvement and service transformation projects are fully integrated into the RNOH s Assurance Framework and supporting risk registers and that the process integrates with developing the Trust s existing key strategies and annual plans e.g. Workforce Strategy, Procurement Strategy, Estates Strategy, IM&T Strategy, Integrated Business Plan, Redevelopment Outline Business Case and Annual Business Plans. 3. Seek assurance that the interdependencies of individual cost improvement and service transformation projects (and related Trust strategies and plans listed above) are monitored and that due consideration is made in project plans as to elements within the direct control of the Trust and those elements which require input from external stakeholders. 4. Receive, advise on and resolve issues reported to the. 5. Act as gatekeepers for and authorisers to proposed changes to the scope of the Transformation Programme scope. Service Transformation Terms of Reference September 2011 2
5. Membership Non-Executive Director (Chair) - Chairman Chief Executive Joint Medical Director. Director of Nursing Finance Director Director of Operations and Transformation Head of Transformation Clinical Director for Clinical Governance Clinical Director RNOH Head of Therapies Director of Human Resources & Corporate Affairs Director of IM&T Invited external stakeholders North Central London Commissioning Agency NHS London representative In attendance: Service transformation project manager (including meeting administration support) 6. Frequency of meetings Meetings shall be held monthly 7. Quorum A quorum shall be five members comprising as a minimum:- Non-Executive Director or Chief Executive Joint Medical Director or representation by Clinical Director Finance Director or senior representation (minimum deputy level) Director of Operations and Transformation or senior representation Director of Nursing or Matron 8. Reporting arrangements RNOH Trust Board structure (See Annex 2 for links between Clinical Governance and Service Transformation ) TRUST BOARD Remuneration Performance Risk Management Clinical Governance Joint Academic & Research Audit Service Transformation 18 Week Recovery Board Children s Services Strategy Group IM&T Service Transformation Terms of Reference September 2011 3
The reports to the Trust Board. After each meeting the Chairman of the, Chief Executive and Director of Operations and Transformation will jointly report the progress of the work of the to the Trust Board. The monitoring reports received by the committee will also be shared with external stakeholders e.g. North Central London Commissioning Agency and NHS London. The will receive reports from the Trust s Clinical Governance to provide assurance that cost improvement and service transformation projects are maintaining and enhancing the RNOH patient experience including quality of care. The Chair of the Clinical Governance will be a member of the Service Transformation. The work of the will also interface closely with the Trust s patient experience group, staff partnership forum and aspirant Foundation Trust membership. (Annex 2) indicates the reporting mechanisms and linkages with the Clinical Governance. 9. Required frequency of attendance by members It is highly important that members attend the Service Transformation on a regular basis. No more than two meetings should be missed in any one year unless due to extenuating circumstances agreed with the chair of the committee. A delegated deputy must attend the meeting in the absence of a Service Transformation member. If in exceptional circumstances a committee member is unable to attend the meeting or send a deputy then, in addition to standard reporting arrangements, a formal summary report of progress made against their areas of responsibility should be provided in a minimum of 5 working days in advance of the meeting for inclusion with the papers. 10. Process for monitoring the effectiveness of all of the above In its reports to the Trust Board, the will review its effectiveness against its objectives, including reviewing and updating membership as necessary. 11. Administration The shall be supported administratively by the service transformation project manager, in consultation with the Chair of the, Chief Executive and Director of Operations and Transformation. The duties of the project manager, in this respect will include: Agreement of agenda with the Director of Operations and Transformation and attendees and collation of papers. Agenda and papers to be circulated a minimum of 5 working days in advance of meeting. Reminding members of forthcoming meetings to ensure the best possible attendance. Taking the minutes and recording of matters arising and updates. Monitoring and follow up of decisions and agreed actions. 12. Review The terms of reference will be reviewed every year or sooner if necessary. Service Transformation Terms of Reference September 2011 4
Annex 1 Overview of key indicators that will be monitored by the RNOH Trust Board and Service Transformation Performance Deliver existing targets and national priorities consistent with 2011/12 operating framework and agreement with NHS London and Commissioners (through North Central London Commissioning Agency). Specific key performance indicators of risk areas to be monitored:- 1. Sustainable delivery of 18 week access targets and median waits in all clinical units. 2. Sustainable delivery of cancer waiting times. Cost Improvement and Service Transformation Plan Key performance indicators:- 1. Annual Business Plan and associated financial plan agreed with NHS London. 2. Financial monitoring demonstrating that in-year financial performance consistent with agreed financial plan as evidenced in monthly/quarterly FIMs returns. 3. Documented detailed underlying project plans for all cost improvement & transformation projects detailing resources required to implement and deliver the defined amount of financial benefit, lead responsibilities, accountabilities and timescales. Monitoring of project and QIPP plans to include reporting against items delivered, assessment of actual impact against plan and risk rating of future actions. The Service Transformation will receive these plans and monitoring reports as evidence that this process is in place. 4. Documented detailed project plans will be supported by a monthly profile of planned savings against which actual savings will be monitored monthly in addition to standard financial reporting. The Service Transformation will receive these plans and monitoring reports as evidence that this process is in place. 5. Embed service line reporting and patient level costing influencing service transformation as evidenced through monthly reporting. 6. The Trust considers that a deviation from the monthly CIP trajectory of higher than 5% to be an indication of significant risk to overall delivery. In such circumstances it would be expected that the actions indicated in the downside mitigation plan that accompanies the OBC would need to be implemented to offset the shortfall. In such circumstances the Trust Board would formally minute whether it considers the agreed overall CIP and service transformation plan financial targets are still achievable. 7. Additional and particular assurance will be required for projects involving significant service reconfiguration leading to significant savings in the later years of the plan. Additional assurance on these through the Service Transformation will be evidenced by external /independent assurance. This will include Overview & Scrutiny, Patient & Public Involvement Group, Partnership Forum and internal audit. Procurement Milestones and Summary Key Performance Indicators The following table summarises the key performance indicators that the Board will sign off as remaining on target at each key procurement milestone. Where the key indicator has not been met, it will be indicated at the Board the scale of risk that this brings to the Trust s plans detailed in the Outline Business Case and associated LTFM and formally confirm whether it considers that the overall plan remains achievable taking into consideration all indicators available at the time. A more detailed breakdown of key performance indicators against project milestones will be agreed and monitored through the service transformation committee. Service Transformation Terms of Reference September 2011 5
Key Milestones Target dates Summary Key Performance Indicator OBC Submission November 2009 (Final February 2010) SHA / DH OBC Approval April 2010 1. Trust Board approval of OBC and associated CIP and service transformation plans. Outline Planning Approval March 2010 2. RNOH Service Transformation Terms of Reference agreed and set up for first meeting April 2010 Health Gateway Review (Gate 2) October 2010 OJEU Advertisement January 2011 3. 2010/11 Annual Plan agreed by Trust Board and NHS London, including 2010 CIP and Service Transformation project implementation resources 4. 18 week access target March milestone met 5. 2009/10 financial outturn delivered on target (evidenced in draft accounts May, audited accounts - June) 6. Detailed project plans for all CIP and service transformation signed off by service transformation committee. 7. 2010/11 Quarter 1 performance and financial targets met (including 18 week spinal deformity trajectory) 8. Monthly Service Line Reporting in place to inform CIP and service transformation plans. 9. Service Transformation confirmation that project plans remain on target 10. 2010/11 Quarter 2 performance and financial targets met (including 18 week spinal deformity trajectory) Shortlist Bidders May 2011 11. 2010/11 performance and financial targets met (including 18 week spinal deformity trajectory) 12. 2010/11 CIP monthly trajectory met 13. 2011/12 Quarter 1 CIP monthly trajectory met 14. 2011/12 Quarter 1 performance and financial targets met Issue ITPD October 2011 15. 2011/12 Quarter 1 & 2 performance and financial targets met 16. 2011/12 Quarter 1 & 2 CIP monthly trajectory met Issue ITSFB / Call for Final Tenders August 2012 17. 20112/13 Quarter 1 & 2 performance and financial targets met 18. 2011/12 Quarter 1 & 2 CIP monthly trajectory met Receive Final Tenders September 2012 19. 2012/13 Quarter 1 & 2 performance and financial targets met 20. 2012/13 Quarter 1 & 2 CIP monthly trajectory met Trust Recommendation to Appoint Preferred Bidder November 2012 ABC Approval May 2013 21. 2012/13 Quarter 3 performance targets and financial targets Health Gateway Review (Gate 3) July 2013 Service Transformation Terms of Reference September 2011 22. 2012/13 Quarter 3 CIP monthly trajectory met 23. Service Transformation and Trust Board receive external/independent assurance that longer term high risk service reconfiguration projects on track 24. 2012/13 Financial targets met (audited accounts) 6
Key Milestones Target dates Summary Key Performance Indicator Treasury Approval of Confirmatory Business Case CBC) November 2013 25. 2013/14 Quarter 1 & 2 performance and financial targets met 26. 2013/14 Quarter 1 & 2 CIP monthly trajectory met 27. Service Transformation and Trust Board receive external/independent assurance that longer term high risk service reconfiguration projects on track Service Transformation Terms of Reference September 2011 7
Annex 2 Links between Service Transformation & Clinical Governance s Clinical Governance Clinical Governance will formally monitor the service transformation committee in relation to patient experience and safety issues Service Transformation Blood Transfusion Medical Records Medicines & Therapeutics Safer Medicines Clinical Risk Outcome Panel Clinical Audit Steering Group Patient Experience Group (PPI & Complaints) Will provide patient and user perspective on proposed changes Infection Control Resuscitation Matron s meeting Nursing Advisory NAC will lead on work streams relating to nursing and AHP role reviews and changes Service Transformation Workforce Sub Senior Sister / Charge Nurse Forum Clinical Nurse Specialist Forum Partnership Forum Full line => Accountable to Dotted line => Communication/Monitoring Service Transformation Terms of Reference September 2011 8