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BOARD STRATEGY SESSION
Agenda Item 3
HELD ON 30 APRIL 2009
IN THE BOARDROOM, ELLIOTT HOUSE, EDINBURGH
Present:
Sir Graham Teasdale
Chairman
Mr M Evans
Board Member and Vice Chairman
Ms V Atkinson
Board Member
Mr B Beacom MBE
Board Member, Chairman of the Scottish Health
Council
Ms A Buchanan
Board Member
Professor J Davies
Board Member
Mr J Jackson
Board Member
Professor P Knight
Board Member
Ms L MacMillan
Board Member
Mr G Marr
Board Member
Mr J Orr
Board Member
Mr D Service
Board Member and Employee Director
Ms P Whittle
Board Member
Ms C Whipps
Board Member
Dr M Winter
Board Member
Ms J Warner
Board Member and Interim Chief Executive
Ms E Moir
Board Member and Director of Nursing / Interim
Director of Implementation and Improvement
Support
Ms H Davison
Acting Director of Guidance & Standards
Ms E Lewis
Director of Planning & Resource Management
Ms A Lumsden
Employee Development Manager
Ms K McKellar
Head of Human Resources
Mr K Miller
Head of Communications
Mr R Norris
Director, Scottish Health Council
Dr I Wallace
Interim Medical Director
Mr B Ward
Acting Head of Finance
Apologies: Dr S Twaddle
Director, SIGN
In attendance:
Mrs J Illingworth
Executive Office Business Manager
(Minute Secretary)
Mr A Masson
Head of Corporate Secretariat
ACTION
1.
WELCOME AND INTRODUCTIONS
The Chairman welcomed Board members and the members of staff
attending the meeting, in particular Jan Warner to her first meeting as
Interim Chief Executive. He also welcomed several new members of
the Board who were appointed on 1 April: Annie Buchanan, Duncan
Service (as Employee Director) and Pam Whittle. Ken Miller, the new
Head of Communications, and Anne Lumsden, Employee
Development Manager were also welcomed.
The Chairman advised the Board of the reappointment of Martyn
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Evans and Mike Winter for a further four years.
Board members were reminded that the private session of the Board
would follow the strategy session, and that lunch would then take
place at 1pm, in advance of the public meeting at 1.30pm.
2.
APOLOGIES
Apologies for absence were received from Sara Twaddle.
3.
STRATEGY SESSION MINUTE
The Board received and approved a note of the Strategy Session held
on 26 February 2009.
The Chairman advised that he would be taking the Strategy Session
part of the Progress Against Action Points paper (agenda item 13.2)
at this stage in the meeting, and that in future the action points would
be discussed during the relevant component of the meeting. The
actions from the previous meeting were read through.
4.
WORK PROGRAMME DEVELOPMENT
The Chairman introduced this item which followed on from discussion
at the February Board meeting of the first year of operation of new
arrangements for developing the work programme. He referred to a
discussion paper which had been circulated and invited Jim Jackson,
Chair of the Programme Board, and the Director of Planning and
Resource Management to lead the discussion.
Mr Jackson highlighted two key points which arose from the
Programme Board’s consideration of the 2009/10 work programme
and the need for a clearer picture of the strategic thinking behind
decisions:
• the desirability of revisiting NHS QIS’ headline objectives with a
more externally-focused view
• the need for a clear and corporate view of the healthcare priorities
the work programme is seeking to address, taking into account
key stakeholders.
In addition, the Director of Planning and Resource Management
suggested that the sheer volume of existing projects and new
proposals considered adds to the complexity of the task.
Consideration needs to be given to the scope, scale and time periods
covered by the work programme.
The Chairman invited Lynne MacMillan and Paul Knight, members of
the Programme Board to comment. They highlighted the importance
of knowledge management in identifying priorities and the need to
look forward, rather than trying to fit pre-existing projects into the
process – to avoid ‘retro-engineering’.
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General discussion took place and the following key points were
noted:
• The Board should develop a clear process for identifying the main
areas to be addressed by NHSQIS, how these should evolve over
time and set a strategy for the corresponding focus and refocusing
of NHSQIS activities.
• The identification and implementation of this strategy will require a
timeframe of longer than one year and it was generally agreed
that a three-year planning cycle will be the most helpful.
• In development of the annual work programme, the Board should
ensure that its broad content fits the strategic pattern it has
established and that there is then a robust process in place, with
clear criteria, for identifying the components within the
programme. The Board would not need direct involvement in the
detailed work behind decisions on individual items, but should be
able to understand and support their outcome. Priorities should
be informed by information on the scale and impact of health
conditions in Scotland.
• Account should be taken of the capacity of not only NHS QIS but
also NHS Boards to be involved in and respond to our activities,
and what we do should be clearly making an impact on needs
identified by the Service.
• In relation to criteria for decision-making, it was suggested that
these should be sequential and used to ‘sift’ proposals, beginning
with their fit with NHS QIS’ strategy, then considering whether
they are healthcare priorities for NHSScotland, before moving
onto more detailed issues.
• It was suggested that although NHS QIS does have a clear vision
and corporate objectives, three of the objectives are about the
way the organisation works and not its external impact. The
challenge is in translating the vision and objectives into high level
aims and priorities for the work programme, based on evidence of
what will create the greatest gain and provide the strongest
assurance.
• One approach to setting the work programme would be to focus
on three key areas: safety risks; public health priorities; and
looking at services of agreed wide importance. This should
involve a PFPI component and leave spare capacity to take on
unplanned work at the request of the Scottish Government.
• The fit of NHS QIS’ work programme with the quality improvement
strategy currently under development by the Health Directorates
should also be considered.
The Chairman summed up, concluding that the role of the Board is to
ensure, at a high level, that mechanisms are in place to set the broad
strategic direction within which the Executive Team can develop a
Jim Jackson
proposed annual work programme, based on clear aims, evidence of
/ Director of
the breadth and depth of healthcare issues in NHSScotland, on
Planning &
capacity and on impact. It was agreed that the proposals in the
Resource
paper should be taken forward and that a progress report would be
Management
made to the Board in June.
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5.
SECURING INTEGRATION IN NHS QIS AND HEALTHCARE
IMPROVEMENT SCOTLAND
The Chairman introduced a paper considering the issues of
integration and independence in relation to NHS QIS and Healthcare
Improvement Scotland (HIS). He highlighted that while diverse
elements have been incorporated into NHS QIS, and will be
incorporated into Healthcare Improvement Scotland, they share a
fundamental requirement for high quality information. Moreover, the
ability to express and to report the information without hindrance is
essential both to the organisation as a whole and to components
within it. He clarified that in this context, the attribute of independence
refers not to organisational ‘separateness’, but to identity and freedom
of expression. It must be possible to sustain and promote identity
along with drawing on and contributing to integration within the
organisation and its independence as a whole.
Mr Evans highlighted the need to look at the reasons behind
independence and the qualities that could characterise it. He quoted
the main requirements for an independent inspection process as set
out by the Scottish Executive when considering the future of the
prisons inspectorate in 2002, pointing out that this organisation is able
to combine scrutiny and improvement.:
1. Inspection needs to be enshrined in legislation, and be
appropriate to the (prison) system being inspected;
2. The inspectorate must enjoy a sufficient degree of independence
to be proof against coercion, obstruction, intimidation or
institutional bias;
3. Resources must be adequate to ensure a sufficient frequency and
breadth of inspection;
4. Personnel must be of the highest integrity and competence;
5. The inspectorate must be able to publish reports and findings
quickly without restraint, and to secure their scrutiny by
appropriate committees;
6. The inspectorate must be free to encourage public and media
discussion of its reports;
7. The findings and recommendations must be able to secure an
adequate response by government and inspected (prison)
authorities.
He noted the move away from governance as the sole determinant of
independence, and highlighted the importance of NHS QIS defining
what it means by independence, particularly to the public. Freedom
to publish is vital but as important is the Service’s response to our
work and the public’s perception of our independence.
It was suggested that while to some people, ‘integration’ means the
‘moulding’ of components into a larger organisation, the creation of
HIS is in fact an opportunity to look at the added value of all of its
constituent parts. Mr Marr drew attention to a Department of Health
White Paper relating to governance between healthcare organisations
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which may provide a useful steer on some of the issues discussed.
It was noted that the paper highlights an important debate, particularly
with increasing tensions between NHS QIS’ scrutiny and
implementation functions. With the shift towards greater scrutiny
comes the challenge of maintaining autonomy in a way visible to the
public, while further strengthening relationships with the Service.
When describing current relationships within the organisation, Mr
Jackson highlighted the importance of both clear delegation and of
collaboration. Mr Evans suggested that no particular part of an
organisation can technically be independent and that the key issues
are around outward focus and the successful and effective operation
of each element.
The perception of NHS QIS’ independence from Ministers was
highlighted as a key issue, and reference made to calls for the HAI
Chief Inspector to be independently appointed. Again the need to be
explicit about NHS QIS’ own criteria for independence was
emphasised.
The Chairman summarised the discussion, noting that a key issue is
the ability of NHS QIS to claim the virtues of independence
summarised by Mr Evans and that this may be undermined if new
parts of the organisation are created with differing degrees of
autonomy. The Board confirmed its commitment to the principles
Executive
discussed and agreed that the Executive Team, in liaison with Mr
Team /
Evans, should develop a framework setting out how these might be
Martyn
applied.
Evans
6.
HEALTHCARE ENVIRONMENT INSPECTORATE
The Interim Chief Executive gave a presentation updating the Board
on developments in relation to the establishment of the Healthcare
Environment Inspectorate.
Board members congratulated the staff involved on their hard work to
develop the framework in a relatively short space of time. Mr Orr,
who is involved on the Board’s behalf in the project, emphasised that
this is an assurance process, using real-time reporting, and that
Boards are ultimately responsible for the outcomes. Referring back to
earlier discussions, he highlighted the need for NHS QIS to have the
capacity to do this type of work, which will be a test of existing
relationships with NHS Boards.
Ms Atkinson highlighted NHS QIS’ duty to involve and report to the
public, and it was agreed that the Board would receive further
Interim Chief
information on this, including the grading system being developed.
Executive
The need for Associate Inspectors to represent the public interest was
highlighted and the establishment of a public interest reference group
was also suggested. The Chairman pointed out to the Board that the
reporting line from the Inspectorate to the Board will place a clear
responsibility on the Board for the content of its findings and how
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these are responded to.
It was agreed that any specific questions or comments relating to the
presentation should be fed back directly by Board members to Ms
Board
Warner.
members
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