NHS Salford Improving Governance Arrangements

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NHS SalfordImproving Governance Arrangements

• Alan Campbell

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• The Journey so farBuilding Organisational
  Governance
• - What is good governance?
• - Where did NHS Salford start?
• - Where have we got to?
• Revising the arrangements
• - Practice Based (Clinical) Commissioning
• - Transforming Community Services
• What next?

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What is good governance?

• By good governance and accountability we mean
• - Focusing on the organisations purpose and on
  outcomes for citizens and users.
• - Performing effectively in clearly defined
  functions and roles.
• - Promoting values for the whole organisation and
  demonstrating the values of good governance
  through behaviour.
• - Taking informed, transparent decisions and
  managing risk.

cont./
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• - Developing the capacity and capability of the
  governing body to be effective.
• - Engaging stakeholders and partners and making
  accountability real.
• - Encouraging continual improvement in public
  services so they meet the changing needs of
  diverse communities and provide fair access for
  all.
• - Stimulating significant improvement in the
  quality of data and the use of information by
  decision makers.
• - Raising standards of financial management and
  financial reporting (stewardship).
• - Challenging public bodies to deliver better
  value for money.

(Audit Commission)
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World Class Commissioning Governance

• The Test
• The Strategy
• The Financial Plan
• The Board

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Where did Salford start?

• 20012008 Unreconfigured, Co Terminus LA
• Strong Metropolitan Council
• Strong Partnership Board framework
• Improving Major Acute Trust
• Consistency in Senior Team
• Very Poor Deprived Population
• Poor Primary Care
• Some Green Shoots from PCG

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Strategy What went well?

• Strong link between Strategic Plan Finance
• Alignment of full Board through strategy
  briefings, discussion workshops and development
  programme (Manchester Business School)
• GP led clinical engagement developed powers,
  co-produced CSP

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What was difficult?

• Practice Based Commissioning Buy
• - 4 Years work
• Prioritising what we do first- Public Health Led
  risk taking (an oxymoron?)
• Ambiguity about Community Health
  ServiceCommissioning
• Full rigour in our business case production and
  procurement- PBC view about pace of change

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Finance what went well?

• Good foundations
• - Use of resources Excellent 2006/7 2007/8
• - Unreconfigured PCT Co Terminus with LA
• Long term planning for system redesign
• - Major redesign 2002-2009 (SHIFT)
• - 10 year financial plan 20032013
• - Major system efficiency initiatives
• - PCT Best Value Cost Minimisation Programme
  2006gt
• Significant devolution of budgets to PBC
• - Incentivised Commissioning
• - Agreement on risk management cross system
• Keep eyes on the quality of care rather than costs

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The Board what went well?

• Good Board Monitoring of Performance
• Strong Evidence of Delegation to PBC
• Salford Health Investment For Tomorrow (SHIFT)
  Redesign of whole economy 2002- 2008
• Fitness for Purpose pilot site 2006
• WCC pilot site 2007/08 Board alignment with
  Priorities
• Briefings and interactive sessions to build
  understanding and agreement

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• Organisational structure
• - Internal capabilities stability
• - Robust Practice Based Commissioning (Took 4
  years hard endeavour!)
• - Greater Manchester collaboration (10 PCTs)
• - Significant integrated working leadership
  with LA
• Joint DPH, Dir of Joint Commissioning, Children's
  Commissioning
• 6 partnership Boards
• Joint Visioning exercise 2006 (common purpose)
• Robust processes and Procedures

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What we missed

• Public Engagement and Involvement on an
  industrialised basis
• Risk Taking ambition/Creativity
• Sufficient challenge from Non Execs
• Provider Market Management

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What next?

• Facing the economic challenge
• Scenario planning for resource changes
• Big System discussions about supply side capacity
  GM NW level
• PCT collaboration and cooperation cross GM
• Local Authority Joint strategic approach The
  same people
• Prioritising in a cold (economic) climate
• Stay on track for Prevention investments
• Balance the impact across Services Prevention

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• Clinical Commissioning Development
• - Wider engagement
• - Sharing the risks
• - Incentivising What's in it for everyone?
• Clarify Procurement rules TCS GP Practice led
  Provision
• Information Intelligence
• - Social Marketing Campaigns Engage the
  population
• - Informing tools Economic Analysis, JSNA, CAA

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Thanks

• Questions?