GovernanceGovernancein thein theHPSSHPSS

The Whole Picture

What is “Governance”?What is “Governance”?

“the system by which an organisation directs and controls its functions and relates to its stakeholders” HM Treasury

In other words, the way in which organisations:

manage their business determine strategy & objectives go about achieving these objectives maintain quality standards engage with and assure stakeholders

What are the drivers for change?What are the drivers for change?

Universal concern about standards of governance

Requirement for wider Statement of Internal Control DAO (DFP) 52001 & DAO (DFP) 25/03

General duty to protect, including Statutory Duty of Quality

Examples of universal concernExamples of universal concern

Cadbury Report Combined Code – Turnbull Report Bristol Royal Infirmary Harold Shipman Senior Executives’ Pay Organ Retention Inquiry Compensation Payments for Clinical Negligence Briggs Case (Lewis Review)

DAO (DFP) 5/2001 – risk management and DAO (DFP) 5/2001 – risk management and the wider Statement on Internal Controlthe wider Statement on Internal Control

Risk Management - The Turnbull report states that a sound system of internal control “depends on a thorough and regular evaluation of the nature and extent of the risks to which the company is exposed”. It further states that the purpose of internal control “is to help manage and control risk rather than to eliminate it”.

Statement on Internal Control - The SIC should therefore be the end result of a process of management that is embedded in the planning, operational, monitoring and review activities of the body, these activities being the critical elements of the statement. Production of the SIC should not be conducted as an “add-on” end of year activity.

Duty to ProtectDuty to Protect

Across the UK, 10% will suffer harm in the NHS– 30,000 deaths– 25,000 permanent disability

Half of these potentially preventable

400 deaths or serious injuries from medical devices 10,000 serious adverse reactions to drugs 1150 suicides amongst people already in contact with social services 28,000 written complaints about clinical treatment 15% of infections may be avoidable £400m in settlements £1bn hospital acquired infections £2bn prolonged hospital stays (£200m in delayed discharges alone)

The nature of riskThe nature of risk

Risk doesn’t recognise internal management boundaries. The systems and controls put in place to manage it must be comprehensive and organisation-wide

Finance

Clinical & Social Care

OrganisationCorporate Risk

Risk management at the heart of Risk management at the heart of governance and assurancegovernance and assurance

Reducing risk is not just about financial or management probity. It is also about improving the quality of services and the user experience of those services. A sound system of organisation-wide risk management must, therefore, be at the heart of all the mechanisms we put in place to offer assurance that these things are happening.

The risk management processThe risk management process

Universal concern about improved governance

DAO 5/2001 – Statement on Internal Control

HPSS duty to protect users, staff and other stakeholders

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Controls assurance standardsControls assurance standards

Supplement but do not replace the need for an organisation-wide system of risk management

Designed to help HPSS bodies to provide evidence that they are doing their reasonable best to manage themselves so as to meet their objectives and to protect users, staff, the public and other stakeholders against risk of all kinds

Will eventually provide the focus for a common approach to controlling key areas of potential risk and reporting on the effectiveness of those controls across the HPSS

Controls assurance standards in place for Controls assurance standards in place for 2003/042003/04

Financial Management (Core Standard)Governance (Core Standard)Risk Management (Core Standard)Medicines Management Human Resources Medical Equipment and Devices

Controls assurance timetableControls assurance timetable

Initial 6 standards published formally in April 2003

HPSS bodies expected to make first reports on compliance in May 2004

Development of further standards continuing during 2003/04

All standards will be introduced within a managed timetable

Best Practice Best Care 2001Best Practice Best Care 2001

A framework to raise the quality of services and to tackle issues of poor performance

Announced in the NI Executive’s first Programme for Government

Why do we need new approach?Why do we need new approach?

Public expectation and growing awareness in the face of scandals

Many services not subject to independent regulation and inspection

Unacceptable variations in the standards of care, treatment and services

The pace of advance in medicine, technology and professional practice

Developments elsewhere in the UK and beyond

The HPSS (Quality, Improvement and The HPSS (Quality, Improvement and Regulation) (NI) Order 2003Regulation) (NI) Order 2003

Statutory Duty of Quality on a par with statutory duty in relation to financial stewardship

Minimum standards of careRegulation and registrationHPSS Regulation and Improvement

Authority

Setting the standardSetting the standard

Links to National Institute for Clinical Excellence (NICE) and Social Care Institute for Excellence

Minimum standards of careEstablishment of HPSS Standards and

Guidelines UnitService Development Frameworks

Monitoring and RegulationMonitoring and Regulation

Extension of regulation to wider range of services

Regulations on minimum standards of careHealth and Personal Social Services

Regulation and Improvement Authority (HPSSRIA)

Clinical and Social Care GovernanceClinical and Social Care Governance

A framework through which HPSS bodies are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical and social care will flourish. It is a concept for the organisation as a whole.

Organisational characteristics of sound Organisational characteristics of sound C&SCGC&SCG

Effective engagement with users, carers and communities in the development, delivery and evaluation of services

Assurance about the quality of care Learning culture where ideas and good practice are celebrated

and shared Effective partnerships for improvement both within and without

the organisation Openness and transparency Commitment to training, education, continuous professional

development, research and audit Staff feel valued and supported Sound knowledge management

Clinical and Social Care Clinical and Social Care Governance – first stepsGovernance – first steps

identify a senior professional at board level to provide leadership in relation to clinical and social care governance by 28 February 2003;

designate a committee with responsibility for clinical and social care governance (or in the case of LHSCGs, a sub-group or team) and supporting structures by 31 March 2003;

complete a review/baseline assessment of arrangements within the organisation that identifies clinical and social care governance support systems and systems that require further development by 31 March 2003; and

formulate and agree the organisation’s plan for developing and maintaining effective clinical and social care governance arrangements by 1 May 2003.

Clinical and Social Care Clinical and Social Care Governance – next stepsGovernance – next steps

Clinical and Social Care Governance Support Team

Review and feedback on original baseline assessment

Feedback on demonstration inspectionUpdate on baseline assessment

2002/03 agenda2002/03 agenda

Adopting a common model for risk management- AS/NZS 4360: 1999

Putting the fundamental structures and processes in place - HSS (PPM) 3/2002 and HSS (PPM) 10/2002

Development of initial controls assurance standards

HPSS (Quality, Improvement and Regulation) (NI) Order 2003

2003/04 agenda2003/04 agenda

Making risk management a functioning reality Mid-term self-assessment HPSS governance and risk management adviser Website development Launch of initial controls assurance standards Working towards compliance Further controls assurance standards Clinical & Social Care Governance baseline Drafting of Care Standards

2004/05 agenda2004/05 agenda

Building general capacity and specific expertise Multi-disciplinary engagement HPSS C&SC Governance Support Team Update on C&SC Governance baseline assessment Harmonisation of overall approach to governance Co-ordinated approach to learning & development First formal reporting on compliance with controls

assurance standards

SummarySummary

2002/03 – establishing the legislative framework and putting the fundamental structures and processes in place

2003/04 – making risk management/controls assurance a working reality and conducting a baseline assessment for clinical and social care governance

2004/05 – building general capacity, developing specific expertise and engendering multi-disciplinary engagement

So how does all of this fit together?

The governance mechanismsThe governance mechanisms

Statutory Duty of Quality

Regulated Care Standards

Service Development Frameworks

Standards and Guidelines

Controls Assurance Standards

Inspection

Audit

Self-Assessment

Professional Peer Review

Performance Assessment

Risk Management

Clinical and Social Care Governance

Regulation of the Professions

Lifelong learning (CPD)

Focus on the user

What are we trying to achieve?

Organisational Characteristics

Lack of vision

Poor objectives

Risk ignorant

Risk averse

Process driven

Self-protective

Blame culture

Inward looking

Silo mentality

Lack of information

Organisational Characteristics

Clarity of vision

Strategic objectives

Risk aware

Risk/opportunity

Outcome focused

Open

Learning culture

Outward looking

Corporate team

Sound knowledge management

Risk Management

Duty of Quality

Regulated Care Standards

C&SC Governance standards

Controls Assurance Standards

Good Governance

HPSSRIA

C & SC Governance