Enclosure 2 THE SHREWSBURY AND TELFORD HOSPITAL NHS TRUST TRUST BOARD – 26 SEPTEMBER 2006 Statement of Requirement for 2006/7 and Board Etiquette BOARD MEMBER Margaret Bamford RESPONSIBLE Chairman AUTHOR (if different from Julia Buckley above) CORPORATE OBJECTIVE 1 – To achieve Foundation Trust status by April 2008 NUMBER(S) (including recurrent financial balance and sound governance arrangements) BUSINESS PLAN OBJECTIVE NUMBER(S) The NHS West Midlands requires the Chair and Chief EXECUTIVE SUMMARY Executive of all NHS organisations to have signed a Statement of Requirements by the end of August 2006, to be subsequently endorsed by the Board at the next meeting. There will be new reporting requirements that include a monthly sign-off form in respect of financial risk and a requirement to submit a quarterly self-certification in relation to governance risk. This requirement mirrors recommendations accepted by the Board from the Integrated Governance Handbook in relation to recognition of obligations and responsibility of Trust Boards. There is also a requirement for the Board to properly exercise its duties, with directors taking care to act reasonably. The Board should recognise the importance of constructive challenge and a suggested guide to board etiquette has been published to facilitate this. KEY FACTS The intention of the NHS West Midlands is that Boards accept the obligations placed upon them by the NHS Operating Framework There will be additional reporting requirements for higher-risk organisations that are being finalised. RECOMMENDATIONS The Board is asked to approve the Statement of Requirements • the proposed Board etiquette . SHREWSBURY & TELFORD HOSPITAL NHS TRUST STATEMENT OF REQUIREMENTS/BOARD ETIQUETTE 1. INTRODUCTION The NHS West Midlands requires the Chair and Chief Executive of all NHS organisations to have signed a Statement of Requirements by the end of August 2006, to be subsequently endorsed by the Board at the next meeting. This is considered an important aspect of Local Delivery Plans, making clear the responsibility of boards for the plans of their organisations and the management of risk, and making clear that Boards accept the obligations placed upon them by the NHS Operating Framework. The Trust has been assigned a risk score of 1, so from September 2006 will be required to submit a declaration of compliance with the Statement of Requirements on a monthly basis for financial risk and a quarterly basis for governance risk, as minimum. This compliance will be on the basis of self- certification. The four areas in the Statement of Requirements (See Attachment 1) are; • financial outturn • activity management • workforce profile; and • commitment to the Governance Framework 2. FINANCIAL RISK SCORE The methodology for deriving the financial risk score is based on the following; • Financial legacy score – as SaTH has formal ‘turnaround’ status it is automatically scored as 1 (very high risk). • Cost improvement plan risk derived as a percentage of operating income • Workforce risk from the percentage reduction in FTE workforce from April 2006 to March 2007 as set out in the FIMs returns. The categorisation of SaTH as very high risk will result in Turnaround-style monitoring and intervention. The form and frequency has not yet been described by the SHA and will be agreed with individual organisations. 3. GOVERNANCE RISK The SHA will assess and rate performance against existing national targets as part of the preparation for the Healthcare Commission’s ‘Annual Health Check and new commitments made in the LDP planning round –these new commitments are; • Implementing relevant NICE Improving Outcomes Guidelines • Maximum 11 week outpatient wait by March 2007 • Maximum 13 week wait for MRI, CT or other diagnostic test by March 2007 • Maximum 20 week wait for inpatient admission by March 2007 • Increase the percentage of patients admitted into treatment, in the financial year, who were retained in treatment for 12 weeks or more. Self-certification returns will be required on a quarterly basis and exception reports will be required where • existing standards are not being met • new commitments look unlikely to be met by March 2007 • performance problems in the six priority areas (health inequalities, cancer waiting times, progress towards 18 weeks maximum waiting times, MRSA, sexual health and access to GUM, Choice & Booking) • serious breaches of acceptable clinical quality, patient safety or other service performance standards The self-certification declarations are shown at Attachment B 4. BOARD ETIQUETTE The SHA recognises that the approach to the assessment of governance risk will only work if there is a degree of openness between Boards and the SHA and early notification of potential problems – the principle of ‘no surprises’ should apply. To facilitate this and to ensure there is an equal degree of openness and transparency between Board members, the Board is asked to consider the attached protocol (Attachment C). This sets out the key principles between Board members and allows for the Chair to lead the Board to review its performance against these standards. This is based on the guidance in the Integrated Governance Handbook and an established protocol and comments received from Board members at development days. 5. RECOMMENDATIONS The Board is asked to (i) Endorse the Statement of Requirements (ii) Note future reporting requirements (iii) Approve the Board protocol and ensure regular review against its standards Attachment A NHS West Midlands Statement of requirements 2006/07 NHS Trust: Royal Shrewsbury & Telford Hospitals NHS Trust Section 1 The Board of Royal Shrewsbury & Telford Hospitals NHS Trust confirms that its Local Delivery Plans for 2006/07 are as set out in returns submitted to the SHA at the end of April 2006 and subsequently revised in resubmitted data at the end of May. The Board hereby confirms that it will manage its affairs in 2006/07 as follows: a. The financial outturn will be at or better than the agreed control total for 2006/07 of balance. b. The Trust will manage activity in 2006/07 in line with activity assumptions for those items which are within its control recognising that outpatient and emergency reforms can only be by joint management with PCT colleagues. c. The Trust changes in the workforce profile (spend and headcount) will be in line with Local Delivery Plans. d. The Trust will maintain existing and new commitments as set out in the Governance Framework (Attachment C). Signed Chair Chief Executive Section 2 The SHA has reviewed the plans of Royal Shrewsbury & Telford Hospitals NHS Trust and has assigned the Trust plans a risk score of 1. This score will determine the performance management relationship between the SHA and Primary Care Trust as set out in Attachment D. The SHA will formally review risk scores monthly and will notify the Primary Care Trust formally of any change. The Board of Royal Shrewsbury & Telford Hospitals NHS Trust hereby agrees to provide to the SHA all monitoring requirements appropriate to its risk rating as set out in Attachment D. Signed Chair Chief Executive Section 3 Starting in September 2006, the Board of Royal Shrewsbury & Telford Hospitals NHS Trust will make to NHS West Midlands a formal declaration of compliance with the Statement of Requirements using the format set of in Attachment E. The declaration will be on a monthly basis for financial risk and on a quarterly basis for governance risk. Signed Chair Chief Executive Attachment B In Year Governance Declarations Boards must confirm compliance with the Statement of Requirements. No supporting detail (in addition to monitoring requirements determined by the organisation’s risk rating) is required unless compliance cannot be confirmed. Please sign one of the two declarations below. If you sign declaration 2, provide supporting details using the form below. Declaration 1a – Finance (Monthly) The Board confirms that its commitments under the Statement of Requirements have been met over the period and that plans are in place to ensure that they will be met going forwards. Signed Chair Chief Executive Declaration 1a – Governance Framework (Quarterly) The Board confirms that its commitments under the Statement of Requirements have been met over the period and that plans are in place to ensure that they will be met going forwards. Signed Chair Chief Executive Declaration 2 For one or more elements of the Statement of Requirements, the Board cannot make Declaration 1 and has provided relevant details below. The Board confirms that all other aspects of the Statement of Requirements have been met over the period and that plans are in place to ensure that they will be met going Signed Chair Chief Executive Please identify which elements of the Statement of Requirements have led to the Board being unable to sign declaration 1. For each please state the reason for being unable to sign the declaration, and explain briefly what steps are being taken to resolve the issue by when: Target/standard: Reason for being unable to sign the declaration: Steps being taken to resolve the issue: _____________________________________________________________ Repeat this format on additional pages as required Attachment C Shrewsbury & Telford Hospital NHS Trust WE WILL WE WILL NOT 1. Respect one another as possessing individual and corporate skills, knowledge and responsibilities 1. Refer to past systems or mistakes as being 2. Show determination, tolerance and sensitivity responsible for today’s situation. - rigorous and challenging questioning, tempered by respect 2. Act as ‘stoppers’ or ‘blockers’ 3. Show group support and loyalty towards 3. Regard any arrangements as unchangeable - The Trust or unchallengeable - each other 4. Adopt territorial attitudes – any members of - the Hospital Executive Group/ Management Executive the team has the right to challenge/question 4. Listen carefully to all ideas and comments and be tolerant to other points of view – be another sensitive to colleagues’ needs for support when challenging or being challenged 5. Avoid giving offence – be ready to apologise 5. Be honest, open and constructive 6. Avoid taking offence – stay open to discussion 6. Be courteous and respect freedom to speak, disagree or remain silent 7. Regard papers presented as being ‘rubber- 7. Regard challenge as a test of the robustness of arguments – ensure no one becomes stamped’ without discussion and agreement isolated in expressing their view. Treat all ideas with respect. 8. Act in an attacking, crushing or dismissive 8. Read all papers before the meeting and clarify any points of detail with the relevant manner author before the meeting, arrive on time and participate wholeheartedly 9. Become obsessed by detail and lose the 9. Focus discussion on material issues and on the resolution of issues, allow differences strategic picture to be forgotten 10. Breach confidentiality – will be candid not 10. Make the most of time – support the Chair, colleagues and guests in maximising secret. scope and variety of viewpoints heard. Individual points are relevant and short. At the end of each meeting will review performance against the above standards Did we use our resources well? Who else should have been here? What helped it go as well as it did? What could we have done better?
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