2What is “Governance”?“the system by which an organisation directs and controls its functions and relates to its stakeholders” HM TreasuryIn other words, the way in which organisations:manage their businessdetermine strategy & objectivesgo about achieving these objectivesmaintain quality standardsengage with and assure stakeholders
3What are the drivers for change? Universal concern about standards of governanceRequirement for wider Statement of Internal Control DAO (DFP) & DAO (DFP) 25/03General duty to protect, including Statutory Duty of Quality
4Examples of universal concern Cadbury ReportCombined Code – Turnbull ReportBristol Royal InfirmaryHarold ShipmanSenior Executives’ PayOrgan Retention InquiryCompensation Payments for Clinical NegligenceBriggs Case (Lewis Review)
5DAO (DFP) 5/2001 – risk management and the 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.
6Duty to Protect Across the UK, 10% will suffer harm in the NHS 30,000 deaths25,000 permanent disabilityHalf of these potentially preventable400 deaths or serious injuries from medical devices10,000 serious adverse reactions to drugs1150 suicides amongst people already in contact with social services28,000 written complaints about clinical treatment15% of infections may be avoidable£400m in settlements£1bn hospital acquired infections£2bn prolonged hospital stays (£200m in delayed discharges alone)
7The nature of riskRisk doesn’t recognise internal management boundaries. The systems and controls put in place to manage it must be comprehensive and organisation-wide
8FinanceOrganisationCorporate RiskClinical & Social Care
9Risk management at the heart of governance 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.
10The risk management process GovernanceClinical and Social CareOrganisationalFinancialObjectivesRisk IdentificationRisk EvaluationControlsAudit and ReviewReporting and AssuranceOrganisation-wide Risk ManagementHPSS duty to protect users, staff and other stakeholdersDAO 5/2001 – Statement on Internal ControlUniversal concern about improved governance
11Controls assurance standards Supplement but do not replace the need for an organisation-wide system of risk managementDesigned 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 kindsWill 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
12Controls assurance standards in place for 2003/04 Financial Management (Core Standard)Governance (Core Standard)Risk Management (Core Standard)Medicines ManagementHuman ResourcesMedical Equipment and Devices
13Controls assurance timetable Initial 6 standards published formally in April 2003HPSS bodies expected to make first reports on compliance in May 2004Development of further standards continuing during 2003/04All standards will be introduced within a managed timetable
14Best Practice Best Care 2001 A framework to raise the quality of services and to tackle issues of poor performanceAnnounced in the NI Executive’s first Programme for Government
15Why do we need new approach? Public expectation and growing awareness in the face of scandalsMany services not subject to independent regulation and inspectionUnacceptable variations in the standards of care, treatment and servicesThe pace of advance in medicine, technology and professional practiceDevelopments elsewhere in the UK and beyond
16The HPSS (Quality, Improvement and Regulation) (NI) Order 2003 Statutory Duty of Quality on a par with statutory duty in relation to financial stewardshipMinimum standards of careRegulation and registrationHPSS Regulation and Improvement Authority
17Setting the standardLinks to National Institute for Clinical Excellence (NICE) and Social Care Institute for ExcellenceMinimum standards of careEstablishment of HPSS Standards and Guidelines UnitService Development Frameworks
18Monitoring and Regulation Extension of regulation to wider range of servicesRegulations on minimum standards of careHealth and Personal Social Services Regulation and Improvement Authority (HPSSRIA)
19Clinical 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.
20Organisational characteristics of sound C&SCG Effective engagement with users, carers and communities in the development, delivery and evaluation of servicesAssurance about the quality of careLearning culture where ideas and good practice are celebrated and sharedEffective partnerships for improvement both within and without the organisationOpenness and transparencyCommitment to training, education, continuous professional development, research and auditStaff feel valued and supportedSound knowledge management
21Clinical and Social Care Governance – 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; andformulate and agree the organisation’s plan for developing and maintaining effective clinical and social care governance arrangements by 1 May 2003.
22Clinical and Social Care Governance – next steps Clinical and Social Care Governance Support TeamReview and feedback on original baseline assessmentFeedback on demonstration inspectionUpdate on baseline assessment
232002/03 agendaAdopting a common model for risk management- AS/NZS 4360: 1999Putting the fundamental structures and processes in place - HSS (PPM) 3/2002 and HSS (PPM) 10/2002Development of initial controls assurance standardsHPSS (Quality, Improvement and Regulation) (NI) Order 2003
242003/04 agenda Making risk management a functioning reality Mid-term self-assessmentHPSS governance and risk management adviserWebsite developmentLaunch of initial controls assurance standardsWorking towards complianceFurther controls assurance standardsClinical & Social Care Governance baselineDrafting of Care Standards
252004/05 agenda Building general capacity and specific expertise Multi-disciplinary engagementHPSS C&SC Governance Support TeamUpdate on C&SC Governance baseline assessmentHarmonisation of overall approach to governanceCo-ordinated approach to learning & developmentFirst formal reporting on compliance with controls assurance standards
26Summary2002/03 – establishing the legislative framework and putting the fundamental structures and processes in place2003/04 – making risk management/controls assurance a working reality and conducting a baseline assessment for clinical and social care governance2004/05 – building general capacity, developing specific expertise and engendering multi-disciplinary engagement
28The governance mechanisms Statutory Duty of QualityRegulated Care StandardsService Development FrameworksStandards and GuidelinesControls Assurance StandardsInspectionAuditSelf-AssessmentProfessional Peer ReviewPerformance AssessmentRisk ManagementClinical and Social Care GovernanceRegulation of the ProfessionsLifelong learning (CPD)Focus on the user