GOVERNANCE REVIEW. Contact Details for further information: Pam Wenger, Committee Secretary.

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1 Joint Committee Meeting 26 January 2016 Title of the Committee Paper GOVERNANCE REVIEW Executive Lead: Chair Author: Committee Secretary Contact Details for further information: Pam Wenger, Committee Secretary. Purpose of the Committee Paper The purpose of this report is to provide an update on the outcome of the Governance Review that was commissioned in Joint Committee / Committee Resolution (insert ) to: APPROVE ENDORSE SUPPORT NOTE Recommendation Members are asked to: NOTE the contents of this report; RECEIVE the Governance Review Final Report and support the recommendations; and AGREE the action plan for implementation which will be monitored by the Integrated Governance Committee. Governance Link to WHSSC Strategic Objective(s) Link to Integrated Commissioning Plan The link should be to organisational objective Specific if the issue included in the report is agreed as part of the Integrated Commissioning Plan including financial impact Governance Review Page 1 of 8 Joint Committee Meeting

2 Supporting evidence Reference here any supporting evidence sourced within this report. Engagement Who has been involved in this work? Executive Board, Management Group, Welsh Government and Joint Committee. This paper has been considered and supported by: Finance Х Clinical Evidence Evaluation Group Х Programme Team Х Executive Board Х Management Group Х Joint Committee Other Commissioner Health Board affected Abertawe Bro Morgannwg Aneurin Bevan Betsi Cadwaladr Cardiff and Vale Cwm Taf Hwyel Dda Powys Provider organisation affected NHS Wales (please state) Х Other NHS Х Other private Summarise the Impact of the Committee Paper Equality and diversity Legal implications Population Health Quality, Safety & Patient Experience Resources Risks and Assurance Standards for Health Services There are no specific implications relating to equity and diversity within this report. There are no specific implications relating to equity and diversity within this report. The updates included in this report apply to all aspects of healthcare, affecting individual and population health. The information summarised within this report reflect issues relating to quality of care, patient safety, and patient experience. There is no direct resource impact from this report. The information summarised within this report reflect financial, clinical and reputational risks. WHSSC has robust systems and processes in place to manage and mitigate these risks. The Board has a duty to ensure the Standards for Health Services in Wales are being embedded across all services. This paper links to Workforce Standard 1: Governance and Accountability. There are no specific workforce implications relating directly to this report. Governance Review Page 2 of 8 Joint Committee Meeting

3 GOVERNANCE REVIEW 1. SITUATION / PURPOSE OF REPORT The purpose of this report is to provide an update on the outcome of the Governance Review that was commissioned in BACKGROUND The scope of the review included: The decision making processes that operate through the current governance model including review of delegations and suggest areas for improvement; Each element of WHSSC governance on its own terms including the Joint Committee; How WHSSC could best fit in the Welsh Government 3 year Integrated Medium Term Planning processes and the Performance Management Framework; How the Local Health Boards could exercise their WHSSC responsibilities more effectively as both commissioner and provider and how WHSSC exercises; How WHSSC can discharge it s responsibilities through the Networks; and How WHSSC can position itself in NHS Wales with Welsh Government and Welsh Ministers. The Joint Committee received an update on the initial feedback from the Good Governance Institute to the Joint Committee in September 2015 and agreed to take forward a number of actions. The final report has now been received from the Good Governance Institute. As agreed at the In Committee Joint Committee in November 2015, the Chair will attend the Chief Executive Peer Group to discuss the final recommendations. The final report and draft action plan is attached. Members are asked to consider and support the recommendations and the action plan. Progress will be monitored by the Integrated Governance Committee. 3. ASSESSMENT OF RISK/GOVERNANCE At the Joint Committee in September 2015 it was acknowledged that the fieldwork was undertaken between November 2014 and February There have been a number of notable improvements in addressing some of the issues highlighted in the attached report. It is acknowledged that many of the recommendations in the report are structural and some would require the support from the Joint Committee and also require changes to the Regulations and Directions. The recommendations also need to be considered alongside the current consultation on the Green Paper and it is an opportunity to highlight any issues as part of the response to the consultation. Governance Review Page 3 of 8 Joint Committee Meeting

4 Major areas of recommendation include: The provision of a programme to develop and agree a national strategy for specialist services in Wales; Health Boards agreeing their reservation and delegation powers to ensure that any strategy and framework allows WHSSC to operate within a properly governed a/c system; the development of a framework for how WHSSC operates and takes decisions; Review the resources within the organisation to delivery a challenging and complex service; and addressing the reputation of WHSSC to develop the credibility and authority that an effective commissioner needs. 3.1 UPDATE ON PROGRESS Since the report was commissioned a number of improvements have been made which relate directly to the recommendations in this report: Appointment of a substantive Chair; Appointment of full-time Nurse Director who has the Executive Lead for implementing the Quality Framework; Appointment of Deputy Medical Director which has resulted in the strengthening of the Clinical Team in the organisation; Agreed a process for the development of the NHS Wales Specialised Services Strategy; Reviewed of the Terms of Reference for the Committees including the Membership; Self Assessment of Committee effectiveness has been undertaken and reported to the Integrated Governance Committee; The processes around managing risk have been strengthened with the agreement of a risk appetite statement. It is acknowledged further work is required in this area and this is part of the planned work programme for this year; The Joint Committee has agreed the need to develop a set of commissioning indicators and this work is being progressed by the Acting Managing Director; The Committee Business Cycle has been reviewed and will be reported to the Joint Committee in March; The Executive Team has in place an OD Programme as a team and has been working with the Director of Workforce in Cwm Taf to integrate the Aston Team Working Model into the organisation; The WHSSC Quality Framework is being progressed with an implementation plan considered by the Joint Committee in November 2015; Plans in place to develop the processes around clinical engagement and programme teams; Greater consistency in terms of attendance at the Joint Committee Meetings especially as they are aligned with the EASC Joint Committee meetings; and Governance Review Page 4 of 8 Joint Committee Meeting

5 Governance Framework in the process of being reviewed as part of the regular review process and the need to split the framework between EASC and WHSSC. A number of recommendations (as detailed in the action plan) can be implemented straight away, as indicated; others will require further consideration and discussion. The attached action plan provides an update on progress in implementing the recommendations. Governance Review Recommendations GGI has compiled a number of recommendations, which are listed below: Recommendations 1. Clarification around the purpose and vision for WHSSC, and reminding stakeholders of this, should be an element of the recently initiated strategy development work. 2. An operating framework should be developed to guide the day-to-day work and decision taking of WHSSC. This should be underpinned by an agreement by the LHB around ethical issues relevant to specialist services. 3. We recommend that the Managing Director of WHSSC is recognised as an Accountable Officer, and is accountable solely to the Chair of WHSSC. The recommendation that the current arrangement of making the Managing Director of WHSSC an executive director reporting to a Health Board is inappropriate. The arrangements for WHSSC s status should be reviewed. At the least and in the short term the hosting of WHSSC should be moved to a national organisation. 4. The independent Chair needs to be part of the Wales Chairs Group that meets with the Minister, in the same way as the Chair of the Emergency Ambulance Services Committee (EASC) does. 5. There should be an explicit role statement for all types of Joint Committee members and deputies, incorporating guidance on potential conflict of interests where members may have provider and commissioner interests. 6. The performance management framework should be revised to include actions or sanctions to be taken on non-compliance with Joint Committee (JC) decisions and on failures in contract performance. 7. Commissioning metrics for the performance management of WHSSC should be developed to evaluate the effectiveness of WHSSC, and these should be monitored centrally. Governance Review Page 5 of 8 Joint Committee Meeting

6 Recommendations 8. Current plans to adjust WHSSC governance structures should consider the need to: Make all directorates accountable for actions in line with WHSSC principles and goals for clinically- driven commissioning Strengthen clinical leadership at JC level and across specialties / networks. This will require a change in Welsh Government Regulations Develop a clinical engagement plan that makes explicit the links between providers and specialty networks; and with Royal Colleges and other advisory bodies. 9. Prioritise the recruitment of a full time Director of Nursing. Implement a development programme that addresses: the Executive Director role Executive team working JC membership roles 10. Review and strengthen the role description for supplementary Independent Members, and consider the appointment of Independent Members who are solely members of the WHSSC JC. 11. Review the requirements and rewards for IMs and AMs. The various groups with IM or AM representations should be reviewed to establish whether they are adding value and link back to assurances WHSSC needs. All groups would benefit from being given a refreshed remit or being brought to a close. 12. The OD plans should include means of benchmarking and learning from peers and peer organisations. We recommend that this includes commissioners in England and especially with Commissioning Support Units. 13. The next stage of the Corporate Assurance Framework should include specification of the roles of each WHSSC group in the assurance system and illustrate this graphically. This should then be communicated and tested within WHSSC. 14. Standardise approaches within LHBs on the escalation of WHSSC risk issues to their Boards. 15. Prioritise actions to embed risk management across WHSSC and include progress as a standing agenda item for the designated assurance committee. 16. The information strategy should be aligned to the new Quality Framework and supported by training and development for key staff. Governance Review Page 6 of 8 Joint Committee Meeting

7 Recommendations 17. A uniform minimum data set required from all providers should be devised, building on that described in the Quality Framework. 18. The principles identified in the proposed Quality Framework should be used as a basis for commissioning criteria. 19. A baseline service specification framework should be agreed. 20. A directorate responsible for quality should be identified, with the Director of Nursing post being its executive lead. Sufficient resource should be provided to support data analysis and quality improvement. 21. The implementation of the Quality Framework, incorporating issues as highlighted in this report and in this section in particular, should be prioritised. 22. A Quality Impact Assessment process for cost improvements, including that within the Quality Framework, should be adopted and implemented as a matter of urgency. 23. The most effective pathways for management and sharing learning from all feedback should be identified and adopted. 24. Review the business cycle in the context of adjustments of the assurance process. 25. Means of engaging stakeholders in decision-making should be clarified and monitored to ensure they are effective. 26. The specific role of the Integrated Governance Committee (IGC) within the assurance structure should be revised in the context of other committees. 27. The attendance of LHB representatives at all meetings should be monitored against requirements and contribution incorporated into evaluation. 28. Evaluate the adequacy of information governance assurance. 29. Specify the seniority and roles of LHB members of the Management Group and devise sanction for non-compliance with attendance. 30. Evaluation of committee effectiveness, of committee proceedings and supports should be implemented as per Standing Orders. Governance Review Page 7 of 8 Joint Committee Meeting

8 4. RECOMMENDATIONS Members are asked to: NOTE the contents of this report; RECEIVE the Governance Review Final Report and support the recommendations; and AGREE the action plan for implementation which will be monitored by the Integrated Governance Committee. Governance Review Page 8 of 8 Joint Committee Meeting