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NHS Tayside Transformation Support Team - Report on NHS Tayside’s progress to implement the recommendations in the Assurance Advisory Group’s Staging Report

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6. AAG Recommendation 6 – Effective Delegation

"Further and appropriate delegation of decision-making to managers and staff at operational level is required in order to ensure that executive director level capacity is released for strategic development and transformation of services."

6.1 NHS Tayside's Assessment – Rating = Amber

"The ERT [Executive Review Team] has specifically re-focussed on strategy and has moved to shift operational management and governance responsibilities to the appropriate level. This will be underpinned by a scheme of delegation covering clinical, operational and financial management. The Board has also commenced implementation of a clinically led and managerially supported approach with a structure designed to empower the clinical service and middle management. Work has also been ongoing to develop an extended Senior Leadership Team and to redefine its leadership role. A number of executive team members have been assigned portfolio lead responsibilities across the 10 recommendations from the AAG Report and a collective, collegiate approach across the ERT is supporting this lead role to ensure active delivery of the outcomes. The executive structure has been revised and, following the senior manager job evaluation by National Evaluation Committee (NEC), a report on progress and cost effectiveness will be considered by NHS Tayside Remuneration Committee.

A corporate governance framework for addressing the accountabilities across NHS Tayside Board and Health and Social Care Partnerships has been developed. There

has been a series of engagement events with professional advisory groups, committees and staff groups and a two day event that identified 7 key themes to be taken forward, including organisational change and leadership. The next stage, to December 2017, will involve completion of revised structures, schemes of delegation and new operational management arrangements together with a management development programme and series of workshops to realign governance, accountability and responsibility at each level. At this stage, given the requirements to complete the governance and structures, the status of this recommendation is assessed as 'Amber'."

6.2 TST Comment - TST Rating = Amber

The TST acknowledges that a great deal of work has been done in developing proposals to redesign the operational team with appropriate clinical and managerial leadership. However, work to explain, implement and support these changes is still in its early stages. Early indications of the effects of this work are beginning to be felt in areas such as the more strategic content of the agendas for Executive Team meetings but effective delegation is not yet working across all levels of the Board in a manner which allows executive director level capacity to be substantively released for strategic development and transformation of services.