Board of Directors (Public) board report

Board of Directors (Public)
Item 8.2
Date of meeting:
Prepared by:
Presented by:
2014/15 CIP and Quality Impact Assessment
27th May 2014
David Jago, Chief Finance Officer
David Jago, Chief Finance Officer
Data Quality
Level of Assurance
(Full / Incomplete/ Concerned /
Immediate Action)
This Board paper provides a high level overview of the Quality Impact assessment
process to date for the 2014/15 Cost Improvement Programme (CIP). It outlines further
actions required and the process and dates for the Board to be able to review the
outcomes of the Quality Impact Assessments (QIA) and the impact and support this will
provide for achieving CIP work streams.
Background and Context
2.1 Delivering sustainable CIP and Monitor
In February 2010 Monitor described a best practice approach to quality
assurance through CIP processes which is detailed below;
2.2 Direction and Focus
The Board of Directors historically have been updated on the Cost Improvement
Programme (CIP) schemes through the monthly Finance report. The CIP schemes each
have a clinical or operational lead who are required to complete the Project Initiation
Documents (PID).These PIDs to outline how each CIP scheme will achieve the required
total savings. Against this PID the CIP lead will complete a Quality Impact Assessment
which is incorporated into our CIP tracker (see Appendix 1).This document is used to
outline the potential Impact on Patient Safety, Clinical effectiveness/ clinical outcomes
and Patient experience. There have been delays in completing the PID’s prior to entering
the new financial year which has led to delays in the QIA’s being brought forward for
consideration by the appropriate Executives. In order for the CIP scheme to formally
progress, the QIA’s need to have been considered. The formal sign off for each PID can
only take place once a QIA has been completed and considered by Chief Nurse, Chief
Operating Officer and Medical Director. Trust senior management team (TSMT) are
currently finalising QIA’s to then be formally reviewed by the executive team and then
signed off. It is anticipated that all schemes will have had formal QIA’s completed by
close of play 23rd May 2014.
2.3 Governance Arrangements
Set out overleaf for the Board of Directors are the current and proposed governance
arrangements for ensuring delivery of the 2014/15 CIP programme does not adversely
impact on quality, patient safety and experience;
TSMT will:
• Ensured overall governance of both Directorate and Trust wide improvement
• Approved and prioritised improvement projects and ensured these are aligned
with the strategic goals of the Trust and the annual business plan.
Improvement Project Steering Groups will:
• Drive delivery of Trust wide improvement projects so that effective plans are
developed, supported, monitored and deliver agreed benefits
• Monitor and report to the Finance committee on progress
• Manage issues, risks and dependencies of, and between projects
Finance Committee will:
• Scrutinise cost improvement projects/schemes, to ensure the Trust delivers its
financial objectives within agreed financial parameters
• Receive reports on the delivery of CIP’s monitored through the Performance
Assurance Meetings and recommend actions with regard to under delivery
Clinical Quality Committee will:
• Be assured that there is an appropriate Quality Impact Assessments (QIA)
process undertaken for each improvement scheme/project valued at greater
than £25k
• Receive bi-annual reports on new and existing Trust wide schemes/projects to
ensure risk planning is robust and the impact on quality and performance is
being thoroughly assessed and negative impact mitigated.
The form and content of reporting the impact of the Trusts Cost Improvement Programme
on quality, patient safety and patient experience to the new formal sub committees of the
Board of Directors is yet to be agreed but it is anticipated that reporting of such will go to
both the Integrated Performance committee for the delivery and performance impact of
service improvement plans and to the Quality committee for scrutiny and review of the
impact on quality.
Following external review of the Trust’s governance arrangements as previously noted
TSMT will be disbanded and replaced by the Operational Board with senior clinical,
nursing and managerial membership. The new governance processes and structure will
bring greater clarity to accountability and responsibility and will support the delivery of a
challenging financial agenda whilst maintaining clear line of sight on the quality of our
service provision.
3. Conclusion
The Board of Directors need to gain assurance on the delivery of the CIP schemes but
equal assurance that we will not compromise quality and safety through the
implementation of any of these schemes. Following completion of all required QIA’s and
review by the Executive team any schemes currently within our programme that are
deemed to have adverse impact on quality and safety will be rejected. The Executive
team scrutiny of the 2014/15 programme and TSMT role as noted above should mean
the rejection of a scheme is highly unlikely but as noted formal receipt and review of
required QIA’s means that this potential risk cannot be ruled out.
4. Recommendation
The Board of Directors are asked to note the current position and urgent time scales for
final sign off for the QIA’s.The Board of Directors are asked to particularly note the
additional discussion and consideration required by the Executives on the workforce
schemes to ensure appropriate governance is applied and if required some amendments
made to some of those schemes, if the risks are felt to be too great to proceed with
individual schemes.
The Board of Directors are asked to agree that the conclusions of the executive
discussions on the workforce CIP schemes following review of QIA’s come back to the
June Clinical Quality Committee and Finance Committee for detailed debate as to the
outcome of those discussions and formal consideration of the impact on the workforce
CIP schemes. It is proposed that a summary of these discussions is presented to the
Board of Directors in June.