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Hywel Dda University Health Board Accountability Report 2018/2019

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Hywel Dda University Health Board Accountability Report 2018/2019 Hywel Dda University Health Board Accountability Report 2018/2019 1 Contents Page Corporate Governance Report Page 3 Annual Governance Statement Page 4 Annual Governance Statement Appendix 1 Page 60 Annual Governance Statement Appendix 2 Page 66 Annual Governance Statement Appendix 3 Page 71 Annual Governance Statement Appendix 4 Page 74 Annual Governance Statement Appendix 5 Page 76 Directors Report Page 79 Remuneration and Staff Report Page 96 Statement of Accountable Officers Responsibility Page 115 2 Hywel Dda University Health Board Corporate Governance Report 2018/2019 3 Hywel Dda University Health Board Annual Governance Statement 2018/2019 4 Annual Governance Statement 2018-2019 Scope of Responsibility The Board is accountable for Governance, Risk Management and Internal Control. As Chief Executive of the Board, I have responsibility for maintaining appropriate governance structures and procedures as well as a sound system of internal control that supports the achievement of the organisation's policies, aims and objectives, whilst safeguarding the public funds and the organisation's assets for which I am personally responsible. These are carried out in accordance with the responsibilities assigned by the Accountable Officer of NHS Wales. Effective governance is derived from more than systems and processes; it is built on strong and enduring relationships which engender trust and cooperation between the Board, Executive Team, staff, partners and stakeholders. The seamless alignment of process and people creates a collegiate governance culture that: Provides a foundation for ensuring that the Hywel Dda University Health Board (HB) is operating effectively and delivering safe, high quality care; Delivers assurance to the Welsh Government (WG), key stakeholders and the public regarding organisational probity and sustainability; and Demonstrates leadership that enables the HB to respond to the significant challenges it continues to face. The HB recognises that the function of governance is to ensure that an organisation fulfils its overall purpose, achieves its intended outcomes for citizens and service users and operates in an effective, efficient and ethical manner. In recognising that governance is a wide-ranging term encompassing concepts such as leadership, stewardship, accountability, scrutiny, challenge, ethical behaviours, values and controls, the essence of Hywel Dda is reflected in its Values and Behaviours Framework, which represents how we do things and the behaviours expected of those working for the HB. The Board is responsible for maintaining appropriate governance arrangements to ensure that it is operating effectively and delivering safe, high quality care. It also recognises the need to govern the organisation effectively and in doing so build public and stakeholder confidence. This is of particular relevance in light of the challenges we face as an organisation and the decisions that were taken when approving the Health and Care Strategy based upon the outcomes from the Transforming Clinical Services programme of work. It has, therefore, been imperative that a robust governance structure has been enacted around the delivery of such major pieces of work during this year, in order to ensure openness and transparency regarding our future plans. The HB has remained at the “Targeted Intervention” level of the NHS Wales Escalation and Intervention arrangements throughout the year, with no further escalation. The rationale for the HB remaining at Targeted Intervention level is reported regularly to both The Board and the Audit and Risk Assurance Committee. The main focus of the discussions has been in relation to the HB’s financial position as the NHS Finance (Wales) Act 2014 requires each HB to prepare a plan which sets out the Board’s strategy for complying with the three year financial duty to breakeven. As it has failed in its duty to have an approved three year IMTP in place for each submission in the period 2014/2015 to 2018/2019, the HB has been in breach of this statutory duty throughout this time. During the year the HB has, with the support provided from the WG, continued to make progress, particularly in respect of the continuous engagement with our population in respect of the development of the Health and Care Strategy and much improved performance in particularly in relating to the significant reduction in referral to treatment times. Whilst the HB 5 has delivered on a wide range of challenging areas during some particularly pressured operational periods with some areas of progress identified and made, the HB’s financial position has remained a dominant factor throughout the year as has the Board’s ability to deliver an approved annual plan for the forthcoming year. All Board members share corporate responsibility for formulating strategy, ensuring accountability, monitoring performance and shaping culture, together with ensuring that the Board operates as effectively as possible. The Board, which comprises individuals from a range of backgrounds, disciplines and areas of expertise, has during the year provided leadership and direction, ensuring that sound governance arrangements are in place. Taking the above principles into account, the principal role of the Board during the year has been to exercise leadership, direction and control as shown in the following figure: Formulate Strategy Understanding of external Setting the strategic direction within overall context and landscapes WG NHS policies; Compelling organisational vision; The Board has a Quality & patient safety at core; comprehensive Longer term view (3 – 5 years); understanding of Financially sustainable; statutory, accountability Workforce needs identified; and organisational Whole system approach; context within which it Clear outcomes and milestones. has to operate. Ensure Accountability Factors Enabling Accurate and timely Rigorous and constructive challenge; Board Clear responsibilities & information and intelligence Leadership accountabilities for staff; ‘Triangulating’ information sources; (Embedding Ensure that Performance Recognising good performance; the Seven Information is reliable to Core Roles Core enable effective scrutiny Seeking assurance that the systems of Principles of & challenge. control are robust and reliable; Public Life) Assurance and reassurance where problems & concerns are evident. Constructive engagement with internal and external Shape Culture stakeholders Commitment to openness, transparency & candour; Effective Board Takes the lead in establishing and engagement regarding promoting values and standards of planning & performance conduct for the organisation & its & is responsive to staff; identified needs. Outward looking; Visible. The Board has an open culture, with its meetings held in public and the meeting papers, as well as those of its committees, available on the HB’s website. The Board has a strong and independent non-executive element and no individual or group dominates its decision making process. The Board considers that each of its non-executive members are independent of management and free from any business or other relationship which could materially interfere with the exercise of their independent judgement. There is a clear division of responsibility in that the roles of the Chair and Chief Executive Officer (CEO) are separate. 6 Board and Committee Membership The Board has been constituted to comply with the Local Health Boards (Constitution, Membership and Procedures) (Wales) Regulations 2009. In addition to responsibilities and accountabilities set out in the terms and conditions of appointment, Board members also fulfil a number of Champion roles where they act as ambassadors for these matters. With the exception of the position of Chair, this year has seen stability in membership from both an Independent Member and Executive Team perspective. Sadly, due to ill health, Bernardine Rees retired from her role as Chair at the end of February 2019 (this role is being undertaken on an interim basis by the HB’s Vice-Chair). The recruitment process is underway, with the new Chair due to commence in post in June 2019. The Board and Committee Membership and Champion roles during 2018/2019 is included as Appendix 1 to this statement. At a local level, NHS organisations in Wales must agree Standing Orders for the regulation of proceedings and business. They are designed to translate the statutory requirements set out in the LHB (Constitution, Membership and Procedures) (Wales) Regulations 2009 into day to day operating practice, and, together with the adoption of a scheme of matters reserved to the Board; a scheme of delegation to officers and others; and Standing Financial Instructions, they provide the regulatory framework for the business conduct of the HB and define - its 'ways of working'. These documents, together with the range of corporate policies set by the Board make up the Governance Framework. The following table outlines dates of Board and Committee meetings held during 2018/2019, with all meetings being quorate: 7 Table 1 Dates of Meeting April May June July Aug Sep Oct Nov Dec Jan Feb March 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 2019 2019 Meeting Board 19.04.18 30.05.18 26.07.18 26.09.18 29.11.18 31.01.19 28.03.19 31.05.18 27.09.18 Audit & Risk Assurance 17.04.18 02.05.18 19.06.18 21.08.18 25.10.18 11.12.18 19.02.19 Committee 30.05.18 Charitable Funds 21.06.18 03.10.18 20.12.18 14.03.19 Committee Quality, Safety & 10.04.18 12.06.18 14.08.18 16.10.18 04.12.18 05.02.19 Experience Assurance Committee Finance Committee 28.09.18 25.10.18 22.11.18 20.12.18 24.01.19 25.02.19 25.03.19 Mental Health Legislation 07.06.18 20.09.18 15.01.19 21.03.19 Assurance Committee Business Planning & 24.04.18 26.06.18 28.08.18 30.10.18 18.12.18 26.02.19 Performance Assurance Committee Primary Care 30.04.18 10.05.18 04.07.18 04.09.18 06.12.18 21.02.19 Applications Committee University Partnership 16.05.18 02.08.18 21.11.18 12.02.19 Board Remuneration & Terms 30.05.19 23.08.18 25.02.19 of Service Committee 8 The Board and its Committees The Committees of the Board, chaired by Independent Members, have key roles in relation to the Governance and Assurance Framework.
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