1. Embedding the golden threads that lead to quality care every time……
Putting governance at the heart of Powys Teaching Health Board: Governance Improvement Programme Progress Update
Embedding the golden threads that lead to quality care every time……
Audit and Assurance Committee: 12 July 2016

2. What we are trying to achieve: Good governance
Engaging and Listening
Empowering and Facilitating
Supporting and Safeguarding
Ensuring quality care and treatment every time
Putting people and quality at the heart of decision making
Audit and Assurance Committee: 12 July 2016

3. The ten key themes of governance we are aiming to address
Clarity of purpose, roles and responsibility
Standards of behaviour
Leadership and strategic direction
Effective external relationships – patients stakeholder, communities
Effective internal relationships
Transparency and public reporting
Systems and structures: quality and safety, boundary issues
Challenge on delivery of agreed outcomes
Risk and compliance
Organisational effectiveness: adding value
Audit and Assurance Committee: 12 July 2016

4. Governance is multifaceted and must operate at many levels.
Governance needs to be based on the concept of subsidiarity, which means that control and responsibility should be pushed down as near to the coalface of delivery as possible. Controls, assurance mechanisms and governance arrangements need to be embedded at the delivery end not just at Board level.
Responsibility for the first line of controls and assurance rests with those who are at the operational level delivering and commissioning the services
Audit and Assurance Committee: 12 July 2016

5. What steps have we taken over the last 6 months?
Audit and Assurance Committee: 12 July 2016

6. Audit and Assurance Committee: 12 July 2016
Taken steps to increase the effectiveness of the Board and its committees
Audit and Assurance Committee: 12 July 2016

7. Audit and Assurance Committee: 12 July 2016
Ensure that the Board and its Committees have sufficient coverage and that there are no gaps in terms of assurance
What we have achieved:
Next Steps:
Reviewed the effectiveness of the Committees established by the Board:
Developed and facilitated a process of self-assessment for each of the Committees
Reviewed the Terms of Reference of each Committee
Developed a Board Work Programme for : aligned to the health board's strategic objectives
Developed Work Programmes for each of the Committees
Strengthened the format of Chairs reports
Review the information needs of the Board and Its Committees
Establish a Stakeholder Reference Group
Establish a Health Professionals Group
Appoint an Independent Member (Trade Union}
Introduce a programme of bi-annual service reviews that will look at the performance of provided and commissioned services.
Develop and engagement map
Develop an engagement plan.
Audit and Assurance Committee: 12 July 2016

8. Audit and Assurance Committee: 12 July 2016
Ensure Board and Board Committee meetings are timely, efficient and effective
What we have achieved:
Next Steps:
Reviewed the timing of Board and Board Committee meetings, ensuring alignment with the availability of information
Developed guidance on the production of Board and committee papers.
Developed a revised Board and Board Committee paper template
Implemented a lead Executive Director report
Introduces Chairs briefing packs for each Board/Committee meeting
Develop a Board and Board Committee Handbook
Reduce the length of meeting agenda’s and meetings: introduce meeting agenda protocol.
Review Executive Team arrangements and increase the frequency of formal meetings
Further strengthen the Committee Chair Board Report
Roll out a programme of training in the production of Board and committee papers.
Develop governance packs for each of the Board committees.
Introduce paperless meetings
Audit and Assurance Committee: 12 July 2016

9. Support Board Members to fulfil their roles
What we have achieved:
Next Steps:
Independent Members issued with identification badges so that they can take part in assurance visits and engagement events.
Independent Members have had a DBS check so that they can take part in assurance visits and engagement events.
Independent Members have access to health board information technology and systems so that they can receive information safely and securely and have easy access to mandatory training.
Annual appraisals for Independent Members completed
Appointments renewed/extended
Develop a succession plan for Independent Members
Develop and implement a Board development programme as well as individual development programmes for Independent Members
Establish an Independent Member’s information section on the Intranet.
Implement monthly ‘Corporate Matters’ newsletters that will provide all Board members with updates on key corporate issues, such as Welsh Health Circulars, freedom of information requests and AM and ministerial letters.
Audit and Assurance Committee: 12 July 2016

10. Audit and Assurance Committee: 12 July 2016
Taken steps to further improve governance structures, processes, procedures, policies and documentation, improve understanding of governance and strengthen the health board’s internal and external audit arrangements.
Audit and Assurance Committee: 12 July 2016

11. Audit and Assurance Committee: 12 July 2016
Review and strengthening of standing orders, standing financial instructions, scheme of delegation and Board Assurance Framework.
What we have achieved:
Next Steps:
Developed guidance and principles for a Board Assurance Framework
Undertook an audit against Standing Orders identifying areas of non-compliance
Implement and embed a Board Assurance Framework
Review and strengthen Standing Orders
Review Standing Financial Instructions
Review and ensure a robust Scheme of Delegation
Develop programme of assurance work to ensure on-going compliance with Standing Financial Instructions
Audit and Assurance Committee: 12 July 2016

12. Audit and Assurance Committee: 12 July 2016
Develop and implement governance procedures, policies and documentation
What we have achieved:
Next Steps
Legal Advice: Developed and consulted on strengthened procedures for the proper management and control of requests for legal advice
Welsh Health Circulars and important documents: Developed and consulted on procedures for their proper management and control
Common Seal: Developed and implemented procedures to ensure the control and proper use of the Common Seal
Declarations of Interest: Developed strengthened procedures for the declaration of interest - to include arrangements related to meetings, procurement, recruitment
Sought declarations of interest from high risk areas of organisation
Policies: Benchmark PTHB policies to ensure that all required policies are in place
AM and ministerial Correspondence: strengthen arrangements.
Consultations: Develop and implement strengthened procedures for the management of the health board's responses to consultations
Policies: Strengthen procedures for the development and approval of policies
FoI: Strengthen procedures to ensure compliant with the Act
Implement the strengthened procedures developed to date
Develop programme of work to ensure on-going compliance with policies
Audit and Assurance Committee: 12 July 2016

13. Improve understanding of governance across the organisation
What we have achieved:
Next Steps:
Embed governance session into induction programmes
Develop and roll-out a programme of governance training
Develop a Corporate Governance Guidance Section for the Internet and Intranet
Audit and Assurance Committee: 12 July 2016

14. Strengthen the health board's internal and external audit arrangements
What we have achieved:
Next Steps:
Worked with Internal Audit to ensure an holistic annual audit programme fro 2016/17 [linked to Assurance Framework]
Improved liaison with External Auditors
Audit Recommendations: Strengthen arrangements for the implementation and monitoring of audit recommendations
Audit and Assurance Committee: 12 July 2016

15. Audit and Assurance Committee: 12 July 2016
Embedding sound risk management and assurance arrangements through developing a risk appetite statement, risk strategy and policy.
Audit and Assurance Committee: 12 July 2016

16. Strengthen the health board’s risk management arrangements
What we have achieved:
Next Steps:
Developed a Risk Appetite Statement
Develop and implement a strengthened Risk Strategy and Related Policy
Develop a strengthened corporate/Board risk register
Clarify the role of the Board Committees in relation to the ‘assurance framework’ and risk management.
Put in place a mechanisms to identify and regularly review the strategic risks linked to our strategic objectives and priorities. Embed sound risk management and assurance arrangements: develop a training programme and on-going review process
Review the risk management and assurance arrangements operating across the health board to test their adequacy. [align to work on the Assurance Framework]
Audit and Assurance Committee: 12 July 2016

17. Audit and Assurance Committee: 12 July 2016
Ensuring governance arrangements take account of all statutory and legislative requirements
Audit and Assurance Committee: 12 July 2016

18. Audit and Assurance Committee: 12 July 2016
Ensure arrangements are in place to meet Welsh Government and legislative requirements
What we have achieved:
Next Steps:
Publish an Annual Governance Statement in line with WG guidance
Publish an Accountability Report
Undertake a review of the legislative requirements placed on PTHB and establish its level of compliance
Develop a legislative compliance programme: purpose to address any identified gaps
Develop an equality and human rights action plan
Develop a programme of equality and human rights training
Develop and implement an integrated equality and legislative impact assessment
Map statutory and legislative requirements to each Committee of the Board
Develop a Legislation Section for the Internet and Intranet
Develop a programme of Welsh language, equality and human rights assurance checks
Audit and Assurance Committee: 12 July 2016

19. Audit and Assurance Committee: 12 July 2016
Ensuring effective management and participation in change programmes and partnership and collaborative working arrangements.
Audit and Assurance Committee: 12 July 2016

20. Audit and Assurance Committee: 12 July 2016
Develop, agree and implement a programme of governance development work to cover the PSB, part 9 Regional Partnership Board, JPB, JMT
What we have achieved:
Next Steps:
Established a Joint Partnership Board
Revised the terms of reference of the Joint Management Board
Developed and agreed a collaborative agreement with PCC
Developed draft joint scrutiny arrangements
Develop a programme of governance
Audit and Assurance Committee: 12 July 2016