Mid Staffs – “It is the job of boards and board members to make choices and balance priorities”

The Health Service Journal (HSJ – 8 October 2009) has reported on the publication by Mid Staffordshire Foundation Trust of a report into the conduct and performance of its previous chief executive Martin Yeates. Mr Yates resigned in May this year after the Mid Staffs board received the report.

According to the HSJ, the report says leadership and management of the trust had improved after Mr Yeates arrived, but confirms the massive failures reported by the Healthcare Commission.

It says: “….we have not seen or heard evidence to subvert the [Healthcare Commission’s] findings that there were significant failures in the leadership and management of the trust over the period of care, and these contributed to poor clinical care.”

The report further states that “Safety and quality of care are clearly of paramount importance in any NHS trust and would therefore need to be given priority in any consideration of the conduct and performance of a chief executive. They are not, however, the only measure of performance and the trust appears to have performed well against some other targets and priorities in recent years and we make reference to some of these later in the report. But performance in one area cannot be at the expense of performance in another, especially where patient care is concerned. It is the job of boards and board members to make choices and balance priorities.”

Readers can download the report on the HSJ’s website here.

Free July regional workshops – Getting the governance right for clinical treatment decision-making

Between 6 and 17 July, the Good Governance Institute, in partnership with the Institute of Healthcare Management, is running a series of free regional workshops around getting the governance right for decision making in clinical treatment.

NHS organisations increasingly need to make sound, fair and transparent decisions in regard to what treatment will and will not be funded, and to explain why. Patients and clinicians expect NHS care to encompass the best, and these workshops will help participants understand the elements to better practice decision making in regard to funding treatment options. Getting this right is an essential element to the World Class Commissioning process.

The product of these workshops will be a template that will help NHS bodies make better decisions about how care services can be organised, and crucially focus on best practice in the fair, defendable limiting of treatment options.

The workshops are part of the Good Governance Institute’s commitment to providing sound, practical support to NHS clinicians and managers. Taking the example of diabetes care the aim is that these workshops produce generalisable materials to improve the standard of decision making and taking in the NHS.

For further information, download the flyer for these events here.

New NHS Evidence site caters for governance

The new NHS Evidence site launched yesterday (30 April 2009) by NICE will, according to NICE, “ allow people working across health and social care – including social workers, commissioners, clinicians, academics and researchers – to access a comprehensive range of sources of clinical and non-clinical evidence to help them make informed decisions about treatments and resources.

“Until now,” says NICE ”evidence of what works to prevent and treat many conditions has been generated, analysed and interpreted by different unaccredited sources. Announced as part of Lord Darzi’s report ‘High Quality Care for All’ (June 2008), NHS Evidence will help users identify the best evidence by sorting, sifting and prioritising a range of information and awarding an accreditation mark to the most reliable and trustworthy sources of guidance. All information submitted for accreditation will be assessed by an independent advisory committee and guidance producers must show they meet a pre-defined set of criteria indicating that their product has been developed using rigorous processes.”

Healthcare Governance Review did a short ‘test drive’ of NHS Evidence searching for all information that contained the word “governance.” A total of 3,804 entries were found.

The new NHS Evidence service can be accessed here.

USA report – A Board of Directors Dashboard for Driving Quality in Acute Care

On November 10, 2008, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services and the U.S. Health Care Compliance Association (HCCA) co-sponsored a government- industry roundtable called Driving for Quality in Acute Care: A Board of Directors Dashboard.

This roundtable focused on how a hospital’s board of directors can use performance scorecards, or dashboards as a tool to promote quality of care in its institution. Dashboard reports use graphics to concisely present critical data in summary form.

Many questions were asked about the creation and use of the dashboard. For example, how do hospitals determine the quality measures to be used? Should the board’s quality committee or medical staff be involved with the creation of the measures? Who, in addition to the board, should be given the dashboard? How frequently should the dashboard be updated? What actions should the board take in response to the information presented in the dashboard? How
can the dashboard be linked to the organization’s strategic plans or objectives? These questions formed the basis of the roundtable presentations and discussions.

Download the roundtable report  Driving for Quality in Acute Care: A Board of Directors Dashboard here.

Report identifies ’serious concerns’ about governance and procedural weaknesses in the awarding of a Managed Facilities Services contract at Whipps Cross University Hospital NHS Trust

Here’s a story we didn’t pick up on in November last year, but the lessons are still highly appropriate for NHS boards.

A report setting out the appointed auditor’s ’serious concerns’ about governance and procedural weaknesses in the awarding of a Managed Facilities Services (MFS) contract at Whipps Cross University Hospital NHS Trust (the Trust) was issued on 18 November 2008. The report, issued under Section 8 of the Audit Commission Act (commonly known as a public interest report) shows that the Trust failed to have adequate arrangements in place to ensure that it achieved value for money from this transaction.

Under the terms of this contract, signed in April 2006, the Trust contracted with a private sector supplier to outsource the management, servicing and replacement of NHS equipment in Theatres and Radiology, for a period of 12 years. As part of this contract, the Trust sold equipment with a book value of around GBP 3 million – GBP 3.5 million, received an initial payment of GBP 7.1 million (plus VAT) and committed to pay charges of GPB 3.2 million per annum for 12 years.

The report’s key findings were:

- The contract procurement, evaluation and approval process was undertaken over an inappropriately short timescale due to a misguided expectation that the contract would result in an accounting gain.
- The Trust’s selection of an ‘accelerated restricted’ procurement process was poorly judged, and it is highly questionable whether the Trust complied with EU rules around negotiation with bidders.
- The tender evaluation and shortlisting process was based on insufficient information, and was poorly documented.
- The Trust did not have adequate arrangements to ensure that the contract represented adequate value for money.
- The Trust has since reassessed the contract and believes that, whilst resulting in some operational improvements, it does not represent value for money.
- The GBP 7.1 million valuation of assets sold to the private sector supplier was significantly overstated.
- The Board did not have the skills or experience to understand and adequately challenge the risks associated with this complex transaction and placed too much reliance on the assurances provided by members of the executive team.
- The Board approved the MFS contract subject to SHA approval, but this was never provided unconditionally nor was there clarity on either side around what level of approval was required.
- The Board did not understand the role of external advisors relied upon in the approval process and as a consequence drew an inappropriate level of assurance from their involvement, even where the advisors’ limitations in scope were clearly set out in terms of reference.
- Significant contract amendments and side letters were negotiated after the contracts without Board approval, and the contract itself was backdated.

Download a copy of the report here.

Irish HSE board rejects good corporate governance?

An article in the Irish Times (7 March 2009) suggests that the board of the Health Service Executive (HSE) in Ireland is seeking to strip the CEO of the HSE of his authority by insisting on having the final say in the appointment of one of his reports – a new director of operations.

Such an approach would indicate a lack of understanding on the part of the board of the fundamental principles of good corporate governance and organisational control. Boards should govern effectively and not seek to ‘meddle’ in the affairs of management. Any board that seeks to diminish the authority of its CEO by making decisions normally reserved to him/her must, implicitly, have lost confidence in that CEO’s ability to manage. In most circumstances this would be a resignation issue for the CEO.

According to the Irish Times article, the HSE’s CEO, Professor Brendan Drumm, may consider resigning.

Read the full article here.

Joseph Rowntree Foundation report on community involvement in the governance of local services

With increasing emphasis placed on the engagement of service users, citizens and communities in government policy, the Joseph Rowntree Foundation (JRF) has published a 70 page report that examines community involvement in the governance of local services, with an emphasis on the role of public officials. Community involvement in governance is defined as “community involvement in shaping local services and policies.”

According to the report, “The role played by public officials in community engagement has important effects on the extent to which community views can influence local services”

The report studies the experiences and views of public officials, comparing a local authority, a police service and a Primary Care Trust in Haringey, North London.

Specifically, the research examines:

- public officials’ perspectives on the purposes of community engagement, the different types of engagement mechanisms used, and the role played by community participants;

- organisational constraints and enablers of community engagement, including senior management support, resources, performance management systems, time frames and organisational culture;

- the informal practices and processes used by public officials to engage with the community and their attitudes and feelings towards it; and

- officials’ views about the extent of community influence and the factors which affected this.

 Download the report, Public officials and community involvement in local services, here.

‘Credit crunch’ could see government ‘raiding’ foundation trust surpluses

The Guardian newspaper last week ran a short article looking at How the financial crisis will affect the health service.

The ‘credit crunch’ is biting and is likely to squeeze public expenditure. Consequently, according to Professor Robert Harris at Monitor, “Foundation trusts need to budget for lower income streams.” He says that ”Many are in a good position because they have made efficiency savings. They should try to insulate themselves by investing in a service they are good at to attract more custom in the future.”

Chris Ham, professor of health policy and management at Birmingham University, is concerned that the government may attempt to claw back surpluses that the government has encouraged them to build up for future investment in patient care. He advises boards to take ”every possible step” to protect their surpluses, including spending them to avoid them being raided by Treasury.

The ‘Informed Decisions Toolbox’ – bringing an evidence-based approach to decision making in management (and governance?)

With evidence-based medicine being a major issue in modern day healthcare, this begs the question why shouldn’t an evidence-based approach also be taken in relation to decision-making in healthcare management and governance.

A team of researchers at the Center for Health Research, University of California at Berkeley, USA, have developed an ‘Informed Decisions Toolbox’ based on information gained from focus group interviews involving over thirty health service managers.

The toolbox provides assistance in relation to obtaining best available information for: 

- evaluating and selecting between different options
- creating support for a decision
- identifying important parameters for the decision-making process
- identifying potential problems associated with each option; and
- reducing uncertainty about a decision

  

Whilst the toolkbox has been developed specifically for management decision-making in healthcare, Healthcare Governance Review believes the tool is equally applicable to decision-making by governing boards.

The Decision Making Toolkit can be freely accessed here.