DH publishes feedback on consultation to remove or suspend chairs and non-executives from PCTs

The Department of Health (DH) has published the results of its consultation to introduce powers of removal and suspension relating to chairs and non-executives from NHS primary care trusts (PCTs) in England.

The consultation results, together with the new legislation enacting the powers, can be found here.

 

IHI produces tool to calculate the cost of adverse events

The Institute for Healthcare Improvement (IHI) in the USA has, in response to widespread interest in making the “business case” for quality, unveiled a new practical tool that can be used to model the financial implications of reductions in adverse event rates.

This tool, the Events Prevented Calculator, allows one to track the change in rate of any one type of adverse event over time, and, when appropriate additional data are added, the consequent change in unnecessary deaths (”lives saved”), real and additional potential cost savings (”dark green dollar” savings and “light green dollar” savings, respectively), and the return on investment of quality improvement work targeting those adverse events.

According to the IHI, the primary purpose of the tool is allow clinical or quality staff to translate the results (or potential results, if hypothetical event data are used) of improvement work into terms and concepts that might be more accessible and relevant to leadership, board, and finance functions.  

The tool can be freely accessed here.

 

NHS South Central seeks ‘Governance Performance Manager’

South Central Strategic Health Authority is looking for a qualified accountant or internal audit professional to lead on the performance management of the corporate governance agenda across the NHS South Central economy, and also provide support to the development and sharing of good governance practice.

The post-holder will work closely with the Boards, Audit Committees and senior managers of constituent Trusts and PCTs. Key tasks will include:

- developing a corporate governance performance management framework against which the post-holder will assess Trust and PCT performance
- attendance at public Board and Audit Committee meetings to assess board and governance performance,
- supporting Trusts and PCTs in the development of their risk management and board assurance arrangements,
- designing and delivering governance training for Senior Managers and Non-Executive Directors.

Potential candidates should have a sound knowledge of NHS governance issues, including effective Boards and Audit Committees, the Board Assurance Framework, risk management and integrated governance. They must also possess excellent communication and influencing skills, and be capable of working closely and credibly with the Directors, Non-Executive Directors and Senior Managers of a range of organisations.

For further information, click here.

 

Surgery death woman ‘failed by the system’

A woman who bled to death following surgery was ‘failed by the system’ according to a report in the Scotsman newspaper today.

According to the report, “Surgeon Michael Dixon said Marlene Wightman had been let down by the unit which cared for her at Edinburgh’s Western General Hospital in March 2006. But he said the failings were probably above any single person, pointing to inadequate training of nurses looking after cancer patients after surgery…………..He said that she was the only patient he had operated on who had died.”

“The inquiry heard that the surgeon could have saved Mrs Wightman’s life if he had been told about worrying levels of blood loss. Mr Dixon previously told the court that “alarm bells should have been ringing” after Mrs Wightman began losing blood in the hours after the mastectomy……..Mr Dixon said patients were being put in the hands of people who were “exposed” and did not have experience.”

At an earlier hearing, the nurse in charge of the hospital ward admitted it was short-staffed and that workers had been “stressed out”.

 

Audit Commission’s latest ‘Financial Health News’ announces forthcoming study on ‘board assurance’

The latest edition of the Audit Commission’s Financial Health News (FHN) - which provides health sector professionals with essential financial health management information, updates on the Audit Commisions’s current work and new national reports, together with editorials about the Commission’s audit work with NHS trusts and Foundation Trusts - contains a number of interesting articles, including:

- update on implementation of Payment by Results (PbR)
- a practical guide to improving medium-term financial planning for PCTs
- Emerging findings from the PbR assurance framework
- Notification of new health studies programme for 2008/09

The new health studies programme will include Board Assurance. According to the Audit Commission, “This study will assess the rigour with which NHS trust and NHS FT Boards assure themselves on the strength of the internal controls to support the accounting officer’s Statement of (sic) Internal Control and therefore the validity of the self assessment and self certifications for regulatory purposes. It will also review the steps Boards take to assure themselves about its quality and the data they receive.”

Current and past issues of FHN can be freely downloaded at the Audit Commissions’s website here.

Plug is pulled on premiere patient safety website

The Saferhealthcare website, a joint venture between BMJ Publishing, the National Patient Safety Agency, and the US Institute for Healthcare Improvement (IHI), is to “shortly go offline.” No reason has been given as to precisely why the parties involved have taken the decision to pull the plug on what appeared to be an informative and generally helpful site. Healthcare Governance Review notes, however, that the site does not appear to have been being properly maintained since October 2007.

NHS board member pay review published

Chief Executives of NHS Trusts now earn a median basic salary of £133,435, according to the latest NHS Salary Survey published by Capita Health Service Partners, and this is just over 5% higher than in the corresponding survey last year.

Finance Directors remain the next highest paid executive directors (excluding Medical Directors), with a median salary of £100,064 in trusts, the equivalent of around 75% of the median salary for Chief Executives.

The survey also shows median pay levels of £45,000 for Chairs and £12,150 for Non-Executive Directors in Foundation Trusts. These levels are higher than for other types of NHS organisations and reflect changes in the role and responsibilities for these posts within Foundation Trusts.

For further information, including how to obtain a copy of the Capita report, click here.

Dealing with ineffective governance in NHS Scotland - the case of Western Isles Health Board

An interesting case study involving the Western Isles Health Board - part of NHS Scotland - in what appears to be a classic case of ineffective NHS governance; and the mechanisms in place to hold senior figures to account.

In essence, the Auditor General (AG) for Scotland produced a Section 22 report on the Health Board following its failure to meet a financial target. This was the third consecutive year the AG had prepared a report on the accounts of the Board. His report points to “a number of serious weaknesses concerning the Board’s corporate governance arrangements.”

His report also states that “The Board has no comprehensive performance management framework in place and corporate objectives were not agreed during 2006/07. There is no committee to oversee performance and no system in place to record and report benefits from pay modernisation. Furthermore, a recent report by NHS Quality Improvement Scotland on clinical governance identified some significant failings, including a lack of clear strategic priorities and a lack of performance monitoring.”

Follow the inquiry into the Section 22 report on Western Isles Health Board here.

UPDATE - Western Isles Health Board has issued a statement saying that it has now achieved financial balance. Read the statement here.
 

MPs point to “inappropriate governance, management and communication by the Department of Health” as root causes of “inept” handling of junior doctors recruitment

According to a BBC report today, “The handling of the junior doctors recruitment crisis last year by the government was inept, MPs say.

The House of Commons’ health committee said the government had provided “inadequate leadership” amid the chaos which saw medics take to the streets.

The cross-party group of MPs said there had been inappropriate governance, management and communication by the Department of Health, while chief medical officer Sir Liam Donaldson had failed to take responsibility despite being the architect of the reforms.

But they also blamed doctors, saying they were more concerned with factional interests than the common good.

The government said it would consider the findings and pointed out it had already apologised for the problems.”

 

Great Chairs and exceptional NEDs

Leadership consultancy specialists Whitehead Mann Partnership have published two guidance documents that may be of interest to healthcare board members.

The first, What makes a great board Chairperson? is based on interviews with 215 mainly current directors of either FTSE 100, FTSE 250, large private companies, private equity companies or public sector bodies. They expressed views about a wide range of Chairpersons they have experienced. Nearly two thirds of the interviewees were either a Chief Executive or a Chairperson. Whitehead Mann’s research suggests ten qualities or skills that all Chairpersons are assumed to have as a prerequisite for getting the job:

1. Thinks strategically
2. Skill to handle media & external pressure groups
3. Executive and Non-Executive Director experience
4. Commands respect and can be taken seriously
5. Gets involved constructively but not into detail
6. High standards of personal accountability /values / ethics
7. Well networked for promotion of organisation
8. Personal presence
9. Intelligent
10. Cool under pressure / can take over in crisis

The second, What makes an exceptional NED? is based on interviews with 124 Chairpersons, Chief Executives, investors and NEDs - who together sit on 552 boards and organisations in the UK. Whitehead Mann’s research has produced a framework comprising ten ‘X Factors’ for exceptional Non-Executive performance as follows:

1. A breadth of experience
2. Team players who leave their ego at the door
3. Independent advisers able to challenge and support
4. Committed and prepared
5. Articulate communicators and good listeners
6. Sharp minds and good judgment
7. Visionary, creative and passionate about business
8. Build strong relationships and act as ambassadors
9. Self-confident without being dogmatic
10. Enhance their contribution through feedback

According to Whitehead Mann, “These factors are not stand-alone or one-offs, but are intertwined. The best NEDs have all these factors, in the right mix to suit their particular profile and situation. There isn’t “one size fits all”.”