Use of Resources Calderdale workshop 18 May 2009 Janet Matthews- Audit Commission Steve Brennan- Calderdale PCT

Objectives Outline process Areas of overlap PCT/ Council High level view Issues from NHS UOR PCT viewpoint What worked well What can be improved

UOR in 2008/09 KLOEs reviewed in 2008/09 mainly the same at CPCT as CMBC but Done at Council not PCT 2.1 Commissioning and procurement 3.1.Natural resources Done at PCT not Council 3.3 Workforce

Areas of overlap between PCT and Council Managing Finances Financial Planning- MTFS developed with social services and JSNA drives MTFS Work with Council in financial planning to understand costs at the disposal of significant partnerships –and can demonstrate how investment has produced more efficient use of resources/ better outcomes

Areas of overlap between Council and PCT KLOE 2.3 Principles and values of good governance partnership governance documented in agreed governance documents between Calderdale Council and NHS Calderdale Calderdale Compact Demonstrate confidence in partnerships- good governance diagnostic at PCT used

Use of Resources- the harder test It is a harder test top down view not a checklist considers outcomes.

The High Level view Level 2 Performs adequately Level 3 Performs well Level 4 Performs excellently* Arrangements that are consistent with established professional practice and guidance, meet statutory requirements and operate effectively. Implemented effective arrangements that are: - forward looking and proactive in identifying and developing opportunities for improvement; and - include more sophisticated measuring and assessment techniques. Demonstrating innovation or best practice. Arrangements sufficient to address the KLOE, demonstrating, for example: organisational leadership and commitment; partnership working; appropriate capacity and skills informed by priorities with supporting action plans as appropriate. Outputs and outcomes demonstrate arrangements which are effective and have the intended impact. Where appropriate, the arrangements show evidence of effective partnership working. Demonstrating strong outcomes for the community including through partnership working. Arrangements that achieve minimum acceptable levels of performance. Evidence of performing consistently above minimum acceptable levels and achieving value for money Evidence of performing well above minimum acceptable levels and achieving excellent value for money.

Issues from NHS use of resources Issues about how systematic / consistent embedded performance is or can we see isolated examples only?. Whole life, social, environmental costs- no examples of this. Partnerships- definition of these? Links between NHS and social care costs.-clear governance arrangements? How are all using LSP to achieve their priorities/ outcomes?. Outcomes are a crucial aspect of the assessment – can they be identified and linked to financial planning and organisational priorities in a systematic way? Can organisations demonstrate progress to outcomes- is something changing as planned and on the right trend line? Are costs reviewed with the link to outcomes? Are savings planned systematically and monitored?. KLOE 2.3 and 2.4 more closely linked to previous assessment areas. Workforce- many have not looked at this area before. How was evidence provided / self assessment done - need to do an overall summary- tell the story

Consistency Consistency- YHSHA wide 28 April but this is different this year not the final consistency. Included comparison against national picture Workforce planning lower scores KLOE 2.3 and 2.4- more similar to previous but do need evidence for outcomes at level 3- survey results etc

PCT viewpoint Do not assume that all in the PCT know what is involved in UOR and why it is being done UOR not a checklist but needed to use the detail as a basis to collect the evidence/ identify key individuals But dividing the assessment up may not help the context UOR not just a finance responsibility- need liaison with key individuals to ensure it is seen as part of the job

PCT viewpoint Starting early was a good thing as it allowed for time to resolve issues- iterative Don’t expect auditors to have the same viewpoint But there was a degree of overlap in the improvement areas identified Auditors need time to understand how it all fits together – how to facilitate this? Meetings held by auditors with key individuals- to understand context and not just document review Difficult to obtain evidence for some outcomes

PCT viewpoint-2009/10 How to collect evidence during the year on an ongoing basis - no World Class Commissioning evidence. Timescale- not just this year- need to look back to see impact of previous decisions, current impact and set up processes for monitoring impact of current decisions Cannot only focus on areas for improvement- need to ensure that all processes continue and outcomes are delivered

What went well for the auditor Self assessment- was down at each assurance- comments against each - linked to evidence – WCC links was an advantage here as PCT had thought about evidence already Knowledge of organisation from attendance at committees – how it works in practice Presentation to PCT SMT- UOR is not just a finance responsibility

Opportunities for improvement Could self assessment/ evidence collection have been at a higher level to tell the story for each area (but this may lead to more audit queries) Need to collect information of outcomes throughout the year Consider how to provide evidence of impact of joint working Need a organisation not just finance approach to UOR